Provider Demographics
NPI:1568410801
Name:SUMMERS, THOMAS J (DO)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:SUMMERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 LONGVIEW WAY N
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-4571
Mailing Address - Country:US
Mailing Address - Phone:740-357-2625
Mailing Address - Fax:
Practice Address - Street 1:8900 N KENDALL DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2118
Practice Address - Country:US
Practice Address - Phone:786-595-9750
Practice Address - Fax:786-595-9349
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2025-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7936207RH0003X
TN3145207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100108630Medicaid
TNQ027057Medicaid
TN6092238OtherBCBS
OH4286381Medicare PIN
TNQ027057Medicaid