Provider Demographics
NPI:1851406201
Name:BRAEMER, LLOYD G (MD)
Entity type:Individual
Prefix:
First Name:LLOYD
Middle Name:G
Last Name:BRAEMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 WEST ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0424
Mailing Address - Country:US
Mailing Address - Phone:530-246-7337
Mailing Address - Fax:530-246-7335
Practice Address - Street 1:1135 WEST ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0424
Practice Address - Country:US
Practice Address - Phone:530-246-7337
Practice Address - Fax:530-246-7335
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA054939208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A549391Medicaid
CAG47403Medicare UPIN