Provider Demographics
NPI:1003818543
Name:SOMMER, PAUL ALLAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ALLAN
Last Name:SOMMER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:PAUL
Other - Middle Name:ALLAN
Other - Last Name:SOMMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:1353 W PALMETTO PARK RD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-3303
Mailing Address - Country:US
Mailing Address - Phone:561-750-3060
Mailing Address - Fax:561-750-3011
Practice Address - Street 1:1353 W PALMETTO PARK RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-3303
Practice Address - Country:US
Practice Address - Phone:561-750-3060
Practice Address - Fax:561-750-3011
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2008-03-11
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
FLPO00002245213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT51378Medicare UPIN
FL65281Medicare ID - Type Unspecified