Provider Demographics
NPI:1972522399
Name:SUM, LAUREN
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:
Last Name:SUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3506 HANSFORD PL
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-4987
Mailing Address - Country:US
Mailing Address - Phone:832-660-1118
Mailing Address - Fax:281-412-9961
Practice Address - Street 1:9515 BELLAIRE BLVD STE B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-4546
Practice Address - Country:US
Practice Address - Phone:713-988-4848
Practice Address - Fax:281-412-9961
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1729213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176307001Medicaid
TX611852Medicare ID - Type Unspecified
TX176307001Medicaid
TX4850990001Medicare NSC