Provider Demographics
NPI:1821392481
Name:SHAWN B SUMMERS MD PLLC
Entity Type:Organization
Organization Name:SHAWN B SUMMERS MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:B
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-234-1991
Mailing Address - Street 1:PO BOX 36680
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85067-6680
Mailing Address - Country:US
Mailing Address - Phone:602-234-1991
Mailing Address - Fax:602-234-3748
Practice Address - Street 1:222 W THOMAS RD STE 102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4493
Practice Address - Country:US
Practice Address - Phone:602-234-1991
Practice Address - Fax:602-234-3748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35794207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty