Provider Demographics
NPI:1861409732
Name:SUMME, JEFFREY LYLE (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LYLE
Last Name:SUMME
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:19031 33RD AVE W
Mailing Address - Street 2:SUITE 314
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4731
Mailing Address - Country:US
Mailing Address - Phone:425-744-0709
Mailing Address - Fax:425-771-1470
Practice Address - Street 1:19031 33RD AVE W
Practice Address - Street 2:SUITE 314
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4731
Practice Address - Country:US
Practice Address - Phone:425-744-0709
Practice Address - Fax:425-771-1470
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WA1198207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1301647Medicaid
WA1301647Medicaid