Provider Demographics
NPI:1134144041
Name:AYMAR, SUMMER CHARISE (DO)
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:CHARISE
Last Name:AYMAR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3854 EAGLE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3333
Mailing Address - Country:US
Mailing Address - Phone:928-757-4002
Mailing Address - Fax:
Practice Address - Street 1:3641 HIGHWAY 95
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-8151
Practice Address - Country:US
Practice Address - Phone:928-704-4334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBA9586263207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBA9586263OtherLICENSE