Provider Demographics
NPI:1992753503
Name:SUMMERS, LAURA B (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:B
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3160 SOUTHGATE COMMERCE BLVD
Mailing Address - Street 2:STE30
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-8549
Mailing Address - Country:US
Mailing Address - Phone:407-859-4540
Mailing Address - Fax:407-859-3815
Practice Address - Street 1:3160 SOUTHGATE COMMERCE BLVD
Practice Address - Street 2:STE30
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-8549
Practice Address - Country:US
Practice Address - Phone:407-859-4540
Practice Address - Fax:407-859-3815
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82342207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG22676Medicare UPIN
FLE6309ZMedicare ID - Type UnspecifiedPROVIDER#