Provider Demographics
NPI:1518120633
Name:SUMMERFIELD, DOUGLAS T (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:T
Last Name:SUMMERFIELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 S ILLINOIS AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-5489
Mailing Address - Country:US
Mailing Address - Phone:641-428-3041
Mailing Address - Fax:641-428-3059
Practice Address - Street 1:1000 4TH ST SW
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-2800
Practice Address - Country:US
Practice Address - Phone:641-428-6999
Practice Address - Fax:641-428-6678
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101246408207R00000X
MN54611207RC0200X
MN105450207RC0200X
IA41014207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA408284OtherANTHEM BC/BS
NC5915367Medicaid
VAPAROtherMULTIPLAN
VAPAROtherCIGNA
VA10061644OtherOPTIMA HEALTH
VA1518120633Medicaid
VAPAROtherVIRGINIA HEALTH NETWORK
VAPAROtherAETNA
VAPAROtherCORVEL/CORCARE
VAPAROtherVA PREMIER HEALTH PLAN
VAPAROtherUSA MANAGED CARE
VAPAROtherUNITED HEALTH CARE/MAMSI
VAPAROtherFIRST HEALTH COMMERCIAL/COVENTRY HEALTH/SOUTHERN HEALTH
VA1518120633Medicaid