Provider Demographics
NPI:1215019856
Name:SUMMERS, ANDREW G (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:G
Last Name:SUMMERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ANDREW
Other - Middle Name:GERNET
Other - Last Name:SUMMERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:800 N MAITLAND AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4499
Mailing Address - Country:US
Mailing Address - Phone:407-660-7010
Mailing Address - Fax:407-660-7106
Practice Address - Street 1:800 N MAITLAND AVE STE 102
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4499
Practice Address - Country:US
Practice Address - Phone:407-660-7010
Practice Address - Fax:407-660-7106
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70411208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5752463OtherAETNA
FL250414600Medicaid
FL32106OtherBCBS
FL5752463OtherAETNA