Basic Information
Provider Information
NPI: 1801841168
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CRAMER
FirstName: TIMOTHY
MiddleName: J
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1407 UNION AVE STE 640
Address2:  
City: MEMPHIS
State: TN
PostalCode: 381043666
CountryCode: US
TelephoneNumber: 9018668360
FaxNumber: 9013022360
Practice Location
Address1: 877 JEFFERSON AVE
Address2:  
City: MEMPHIS
State: TN
PostalCode: 381032807
CountryCode: US
TelephoneNumber: 9014484454
FaxNumber: 9014485352
Other Information
ProviderEnumerationDate: 05/24/2006
LastUpdateDate: 05/22/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202X43593TNY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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