Basic Information
| Provider Information | |||||||||
| NPI: | 1992749329 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRAMER | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | LOVETT | ||||||||
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| Credential: | DO | ||||||||
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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: | 1 MERCY LN STE 505 | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719136462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016232781 | ||||||||
| FaxNumber: | 5016232405 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 04/15/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | J7038 | TX | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 208100000X | J7038 | TX | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 2084N0400X | E-10819 | AR | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 113719204 | 05 | TX | MEDICAID | 8U7183 | 01 | TX | BCBS | OTHER |