Provider Demographics
NPI:1265471650
Name:SUMMERS, WILLIAM C (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:SUMMERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6188 MACKENZIE VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-3477
Mailing Address - Country:US
Mailing Address - Phone:314-686-9714
Mailing Address - Fax:833-529-0574
Practice Address - Street 1:3915 WATSON RD STE 202
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-1251
Practice Address - Country:US
Practice Address - Phone:314-244-3818
Practice Address - Fax:888-464-1108
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2007010580207RI0200X
TN39419207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09752214Medicaid
MO204589808Medicaid
TN3721649Medicaid
TN4102661OtherBCBS OF TN
MS09016197Medicaid
TN3327876Medicaid
TN3327876Medicaid
MOI25744Medicare UPIN
TN3721649Medicaid
125744Medicare UPIN
MO311301212Medicare PIN