Provider Demographics
NPI:1477502607
Name:SUMNERS, JOHN HERBERT (PHYSICIAN)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HERBERT
Last Name:SUMNERS
Suffix:
Gender:M
Credentials:PHYSICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 COTTON GIN RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-3557
Mailing Address - Country:US
Mailing Address - Phone:334-260-9129
Mailing Address - Fax:334-260-9665
Practice Address - Street 1:420 COTTON GIN RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3557
Practice Address - Country:US
Practice Address - Phone:334-260-9129
Practice Address - Fax:334-260-9665
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000062132080A0000X
AL00062132080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51006226OtherBLUE CROSS BLUE SHIELD
AL000006226Medicaid
AL51006226OtherBLUE CROSS BLUE SHIELD
ALC76884Medicare UPIN