Provider Demographics
NPI:1164566030
Name:GARDNER, SUMMER L (MD)
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:L
Last Name:GARDNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUMMER
Other - Middle Name:L
Other - Last Name:CLEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:411 DUNE CIR
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2142
Mailing Address - Country:US
Mailing Address - Phone:253-670-0970
Mailing Address - Fax:
Practice Address - Street 1:411 DUNE CIR
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2142
Practice Address - Country:US
Practice Address - Phone:253-670-0970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-15777207L00000X
WAMD60080814207L00000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2003674Medicaid
WAG8886568Medicare PIN