Provider Demographics
NPI:1093721623
Name:SOMMERS, KEITH ERIC (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:ERIC
Last Name:SOMMERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1289
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33601-1289
Mailing Address - Country:US
Mailing Address - Phone:813-660-6950
Mailing Address - Fax:813-660-6622
Practice Address - Street 1:5 TAMPA GENERAL CIR STE 860
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3573
Practice Address - Country:US
Practice Address - Phone:813-660-6950
Practice Address - Fax:813-660-6622
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74265208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250809500Medicaid
FL32184OtherBLUE CROSS BLUE SHIELD
FL990009540Medicare PIN
FL32184OtherBLUE CROSS BLUE SHIELD
FL32184YMedicare PIN