Basic Information
| Provider Information | |||||||||
| NPI: | 1316962335 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRAMER | ||||||||
| FirstName: | W | ||||||||
| MiddleName: | DAMIAN | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2050 S BLOSSER RD | ||||||||
| Address2: | |||||||||
| City: | SANTA MARIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934587310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8053618028 | ||||||||
| FaxNumber: | 8053618097 | ||||||||
| Practice Location | |||||||||
| Address1: | 1057 E GRAND AVE | ||||||||
| Address2: | |||||||||
| City: | ARROYO GRANDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934202504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054817220 | ||||||||
| FaxNumber: | 8054817097 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 06/26/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 20A5234 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | W1508C | 01 | CA | PTAN, BK832W | OTHER | W1508 | 01 | CA | PTAN, BK832Z | OTHER | W1508D | 01 | CA | PTAN, BK832V | OTHER | W1508E | 01 | CA | PTAN, BK832X | OTHER | W1508A | 01 | CA | PTAN, BK832Y | OTHER | FHC70693F | 05 | CA | MEDICAID |