Basic Information
| Provider Information | |||||||||
| NPI: | 1588894323 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUMMERS | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | STREET | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1305 W 34TH ST | ||||||||
| Address2: | STE. 308 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787051923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124598082 | ||||||||
| FaxNumber: | 5124585446 | ||||||||
| Practice Location | |||||||||
| Address1: | 1305 W 34TH ST | ||||||||
| Address2: | STE. 308 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787051923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124598082 | ||||||||
| FaxNumber: | 5124585446 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2009 | ||||||||
| LastUpdateDate: | 10/23/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | P4827 | TX | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 336122201 | 05 | TX | MEDICAID |