Provider Demographics
NPI:1124018692
Name:SUMMA, JAMES ANGELO (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ANGELO
Last Name:SUMMA
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 5316
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75608-5316
Mailing Address - Country:US
Mailing Address - Phone:903-663-7393
Mailing Address - Fax:903-663-7394
Practice Address - Street 1:529 N GALLOWAY AVE
Practice Address - Street 2:SUITE 16
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-3420
Practice Address - Country:US
Practice Address - Phone:972-216-4411
Practice Address - Fax:972-216-7346
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ83872085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82435GOtherBC BS
TX103752502Medicaid
TXB008OtherCHAMPUS
TX82435GOtherBC BS
TX83925RMedicare ID - Type Unspecified