Provider Demographics
NPI:1548306871
Name:SUMMERS, WILLIAM KOOPMANS (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:KOOPMANS
Last Name:SUMMERS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6000 UPTOWN BLVD NE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4148
Mailing Address - Country:US
Mailing Address - Phone:505-878-0192
Mailing Address - Fax:505-888-6000
Practice Address - Street 1:6000 UPTOWN BLVD NE
Practice Address - Street 2:SUITE 308
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4148
Practice Address - Country:US
Practice Address - Phone:505-878-0192
Practice Address - Fax:505-888-6000
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2018-01-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM93406207R00000X, 2084P0800X
CAG30330207R00000X, 2084P0800X
NV11010207R00000X, 2084P0800X
AZ509272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000R9183Medicaid
NM000R9183Medicaid