Provider Demographics
NPI:1104815760
Name:KRAMER, WILLIAM FREDERICK (DO)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:FREDERICK
Last Name:KRAMER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 E BIDWELL ST
Mailing Address - Street 2:3-266
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3315
Mailing Address - Country:US
Mailing Address - Phone:717-364-0954
Mailing Address - Fax:
Practice Address - Street 1:705 E BIDWELL ST
Practice Address - Street 2:SUITE 3-266
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3315
Practice Address - Country:US
Practice Address - Phone:717-364-0954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2016-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A13886207RG0300X, 208D00000X
PAOS006345L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012436760002Medicaid
PA0012436760002Medicaid
PA667495GLCMedicare ID - Type Unspecified