Individual
PAUL R SUMMERSIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2253 W MASON ST, GREEN BAY, WI 54303-4706
(920) 327-7250
(920) 327-7249
Mailing address
614 RANDALL AVE, DE PERE, WI 54115-2640
(920) 327-7250
(920) 327-7249
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
29836
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31449300
—
WI
Enumeration date
07/21/2006
Last updated
02/09/2016
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