Individual
DR. JACK PEARSON SUMMERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5418 W BUCKSKIN RD, POCATELLO, ID 83201-9126
(208) 233-8209
Mailing address
5418 W BUCKSKIN RD, POCATELLO, ID 83201-9126
(208) 233-8209
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M3586
ID
Other
Enumeration date
03/06/2007
Last updated
07/08/2007
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