Provider Demographics
NPI:1992026751
Name:SUMMERS, TERESA DAWN (MD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:DAWN
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:DAWN
Other - Last Name:MINCHEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:449 W 23RD STREET
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405
Mailing Address - Country:US
Mailing Address - Phone:850-769-8341
Mailing Address - Fax:904-308-2908
Practice Address - Street 1:449 W 23RD ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405
Practice Address - Country:US
Practice Address - Phone:904-308-7372
Practice Address - Fax:904-308-2908
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD205827207Q00000X
FLME114497207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2332252Medicaid