Provider Demographics
NPI:1679828552
Name:JOSHUA A SUMMERS MD PA
Entity Type:Organization
Organization Name:JOSHUA A SUMMERS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:ALTON
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-634-2207
Mailing Address - Street 1:3878 E COUNTRY SIDE DR
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-8834
Mailing Address - Country:US
Mailing Address - Phone:352-634-2207
Mailing Address - Fax:
Practice Address - Street 1:3878 E COUNTRY SIDE DR
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-8834
Practice Address - Country:US
Practice Address - Phone:352-634-2207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty