Provider Demographics
NPI:1194739417
Name:SUMMER-BRASON, BEATA W (DO)
Entity type:Individual
Prefix:
First Name:BEATA
Middle Name:W
Last Name:SUMMER-BRASON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 KAI MAKANI LOOP
Mailing Address - Street 2:#202
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-5501
Mailing Address - Country:US
Mailing Address - Phone:808-442-5503
Mailing Address - Fax:
Practice Address - Street 1:888 S KING ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3009
Practice Address - Country:US
Practice Address - Phone:603-334-2039
Practice Address - Fax:603-433-5180
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12858208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH04Y008781NH01OtherANTHEM BCBS #
NH30223911Medicaid
NHP00268210OtherRR MCR #
NHP00268210OtherRR MCR #
NHBS9391537OtherDEA #
NHI45929Medicare UPIN
NH04Y008781NH01OtherANTHEM BCBS #