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General NPI Number Information
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NPI Number | 1265652846
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Entity Type | Individual
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Provider Name | NATHAN SHANE SUMNER M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 81MDOS/SGOMU 301 FISHER STREET STE 1F-130
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City | KEESLER AFB
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State | MS
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Zip | 39534-2519
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Country | US
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Telephone | 228-376-3791
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Fax |
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Provider Business Mailing Address
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Address Line | 81MDOS/SGOMU 301 FISHER STREET STE 1F-130
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City | KEESLER AFB
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State | MS
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Zip | 39534-2519
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Country | US
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Telephone | 228-376-3791
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | MD.28744
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License Number State | AL
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