=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306172465
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT C SUMMERS AUD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2009
-----------------------------------------------------
Last Update Date | 04/20/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 620 JOHN PAUL JONES CIR
-----------------------------------------------------
City | PORTSMOUTH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23708-2111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-953-0425
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5072 COPPERFIELD DR
-----------------------------------------------------
City | PACE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32571-6225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-375-4365
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | 1860
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------