Provider Demographics
NPI:1518943372
Name:SUMMER, CRAIG N
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:N
Last Name:SUMMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CRAIG
Other - Middle Name:N
Other - Last Name:SUMMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 173862
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-3862
Mailing Address - Country:US
Mailing Address - Phone:303-306-7783
Mailing Address - Fax:303-306-7753
Practice Address - Street 1:4567 E. 9TH AVENUE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-5337
Practice Address - Country:US
Practice Address - Phone:303-320-2455
Practice Address - Fax:303-306-7753
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35478207P00000X
CODR.0035478207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO930040321OtherRAILROAD MEDICARE
CO01354786Medicaid
CO01354786Medicaid
CO930040321OtherRAILROAD MEDICARE