Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 15838 | TN |
NPI | 1376568709 |
---|---|
Provider Name | Robert Summitt |
First Address | Bartlett, TN 38133-2760 |
Second Address | Germantown, TN 38138-1753 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 01/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00116255 | (05) | MS |
2616901 | CIGNA (01) | |
3891067 | (05) | TN |
4077772 | BCBS TN (01) | TN |
4106878 | AETNA HMO (01) | |
85291 | BCBS AR (01) | AR |
D71861 | (02) | |
P00325421 | RAILROAD MEDICARE (01) | TN |