Provider Demographics
NPI:1578763140
Name:SUMMEY, BRETT JR (MD)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:SUMMEY
Suffix:JR
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 1:169 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5069
Mailing Address - Country:US
Mailing Address - Phone:828-264-4553
Mailing Address - Fax:828-264-4941
Practice Address - Street 1:169 BIRCH ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5069
Practice Address - Country:US
Practice Address - Phone:828-264-4553
Practice Address - Fax:828-264-4941
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-00267207ND0900X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5911668Medicaid
NC5911668Medicaid
NC0800Medicare PIN