Basic Information
| Provider Information | |||||||||
| NPI: | 1598926479 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EDWARD L. KRAMER, D.O., P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4916 CAMP BOWIE BLVD | ||||||||
| Address2: | 108 | ||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761074196 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177314070 | ||||||||
| FaxNumber: | 8177314155 | ||||||||
| Practice Location | |||||||||
| Address1: | 4916 CAMP BOWIE BLVD | ||||||||
| Address2: | 108 | ||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761074196 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177314070 | ||||||||
| FaxNumber: | 8177314155 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2008 | ||||||||
| LastUpdateDate: | 06/23/2008 | ||||||||
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| AuthorizedOfficialLastName: | KRAMER | ||||||||
| AuthorizedOfficialFirstName: | EDWARD | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8177314070 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. , P.A. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | J7038 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 00640Z | 01 | TX | PTAN | OTHER |