Provider Demographics
NPI:1790112662
Name:MARY F. SUMMERS, M.D., APM LLC
Entity Type:Organization
Organization Name:MARY F. SUMMERS, M.D., APM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-250-7264
Mailing Address - Street 1:1460 S COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2912
Mailing Address - Country:US
Mailing Address - Phone:337-233-3368
Mailing Address - Fax:337-233-3367
Practice Address - Street 1:1460 S COLLEGE RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2912
Practice Address - Country:US
Practice Address - Phone:337-233-3368
Practice Address - Fax:337-233-3367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-08
Last Update Date:2014-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.204782207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty