Basic Information
| Provider Information | |||||||||
| NPI: | 1659891687 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUMMERS | ||||||||
| FirstName: | GARTH | ||||||||
| MiddleName: | KELLOGG | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 1ST ST NW STE 101 | ||||||||
| Address2: | |||||||||
| City: | MASON CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 504012932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6414285100 | ||||||||
| FaxNumber: | 6414285115 | ||||||||
| Practice Location | |||||||||
| Address1: | 1010 4TH ST SW | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | MASON CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 504012857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6414285100 | ||||||||
| FaxNumber: | 5414285115 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2017 | ||||||||
| LastUpdateDate: | 02/02/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | NE | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207V00000X | 05809 | IA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.