Provider Demographics
NPI:1134105463
Name:KRAMER, JARED S (MD)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:S
Last Name:KRAMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1113 SHERMAN STREET
Mailing Address - Street 2:PO BOX 406
Mailing Address - City:ST PAUL
Mailing Address - State:NE
Mailing Address - Zip Code:68873-0406
Mailing Address - Country:US
Mailing Address - Phone:308-754-4421
Mailing Address - Fax:308-754-2303
Practice Address - Street 1:1113 SHERMAN STREET
Practice Address - Street 2:
Practice Address - City:ST PAUL
Practice Address - State:NE
Practice Address - Zip Code:68873-0406
Practice Address - Country:US
Practice Address - Phone:308-754-4421
Practice Address - Fax:308-754-2303
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22663207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE22663Medicaid
NE22663Medicaid
NE279015Medicare ID - Type Unspecified