Provider Demographics
NPI:1104927136
Name:CUMBA, SUMMER D (PA)
Entity type:Individual
Prefix:MRS
First Name:SUMMER
Middle Name:D
Last Name:CUMBA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 MEDICAL PLAZA CT
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-5653
Mailing Address - Country:US
Mailing Address - Phone:817-279-1776
Mailing Address - Fax:817-279-7206
Practice Address - Street 1:1212 MEDICAL PLAZA CT
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-5653
Practice Address - Country:US
Practice Address - Phone:817-279-1776
Practice Address - Fax:817-279-7206
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03637363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D6539Medicare ID - Type Unspecified