Provider Demographics
NPI:1174938997
Name:SOMMERS, LAINE D (DO)
Entity type:Individual
Prefix:
First Name:LAINE
Middle Name:D
Last Name:SOMMERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 CORPORATE CENTER DR UNIT B
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-1168
Mailing Address - Country:US
Mailing Address - Phone:937-684-4220
Mailing Address - Fax:937-684-4320
Practice Address - Street 1:505 CORPORATE CENTER DR UNIT B
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-1168
Practice Address - Country:US
Practice Address - Phone:937-684-4220
Practice Address - Fax:937-684-4320
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-01
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.012755207Q00000X
OH34012755207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1234OtherN/A