Individual
MR. WARREN RANDALL SUMNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3003 W DR MARTIN LUTHER KING JR BLVD, MAB 2ND FLOOR, TAMPA, FL 33607-6307
(813) 321-6580
(813) 443-8185
Mailing address
PO BOX 10744, CLEARWATER, FL 33757-8744
(727) 532-0002
(727) 266-4943
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
003541
GA
363AS0400X
Surgical Physician Assistant
003541
GA
363AS0400X
Surgical Physician Assistant
Primary
PA9108734
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01067693
AMERIGROUP
GA
05
—
0155PA
—
SC
05
—
015768600
—
FL
05
—
100001160D
—
GA
01
—
404215
WELLCARE
GA
01
—
P00679501
RR MEDICARE
GA
Enumeration date
10/25/2005
Last updated
02/10/2022
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