Provider Demographics
NPI:1760726947
Name:SUMMERS, STEPHEN MONROE (DOM)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MONROE
Last Name:SUMMERS
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3916 CARLISLE BLVD NE STE A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-4535
Mailing Address - Country:US
Mailing Address - Phone:505-310-9008
Mailing Address - Fax:888-314-6745
Practice Address - Street 1:3916 CARLISLE BLVD NE STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4535
Practice Address - Country:US
Practice Address - Phone:505-310-9008
Practice Address - Fax:888-314-6745
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-12
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM239171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist