Provider Demographics
NPI:1922443258
Name:SUMMERS, SHAWN K (DPM)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:K
Last Name:SUMMERS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 RACQUET LN
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-6109
Mailing Address - Country:US
Mailing Address - Phone:509-225-3668
Mailing Address - Fax:509-225-3448
Practice Address - Street 1:2400 RACQUET LN
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-6109
Practice Address - Country:US
Practice Address - Phone:509-225-3668
Practice Address - Fax:509-225-3448
Is Sole Proprietor?:No
Enumeration Date:2013-04-30
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO60361202213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery