MEDICARE: JOHN J. SUMMERS, M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	A17969	CA

General Provider Information

NPI Number	:	1770517930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN J. SUMMERS, M.D.

Provider Business Mailing Address
First Line	:	1300 N VERMONT AVE
Second Line	:	1009
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-6005
Country	:	US
Telephone Number	:	323-666-6210
Fax Number	:	323-666-6240

Provider Business Practice Location Address
First Line	:	1300 N VERMONT AVE
Second Line	:	#1009
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-6005
Country	:	US
Telephone Number	:	323-666-6210
Fax Number	:	323-666-6240

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN J. SUMMERS
Credential	:	M.D.
Telephone Number	:	323-666-6210

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	06/28/2011

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