Provider Demographics
NPI:1528067816
Name:SUMMERS, JEFFREY SCOTT (MD)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:SCOTT
Last Name:SUMMERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6612 MAYNARDVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-4817
Mailing Address - Country:US
Mailing Address - Phone:865-688-1584
Mailing Address - Fax:865-688-1581
Practice Address - Street 1:6612 MAYNARDVILLE HWY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-4817
Practice Address - Country:US
Practice Address - Phone:865-688-1584
Practice Address - Fax:865-688-1581
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26566207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3125163OtherBCBST
TN5130096OtherRAILROAD MEDICARE
TNTN0101OtherJOHN DEER
TN0689048OtherCIGNA
TN5130096OtherAETNA
TN0441416OtherUNITED HEALTHCARE
TN3094778Medicaid
TN3125163OtherBCBST
G11723Medicare UPIN