Provider Demographics
NPI:1033115100
Name:SUMNER, RICHARD ELLIS (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ELLIS
Last Name:SUMNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6740 CROSSWINDS DR N
Mailing Address - Street 2:STE C
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-5472
Mailing Address - Country:US
Mailing Address - Phone:727-381-5432
Mailing Address - Fax:
Practice Address - Street 1:6740 CROSSWINDS DR N
Practice Address - Street 2:STE C
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-5472
Practice Address - Country:US
Practice Address - Phone:727-381-5432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0049170207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL05797ZMedicare PIN
FLD51424Medicare UPIN