Provider Demographics
NPI:1235130550
Name:CRAMER, W OWEN (MD)
Entity Type:Individual
Prefix:
First Name:W
Middle Name:OWEN
Last Name:CRAMER
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 1:1315 ST JOSEPH PKWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-8235
Mailing Address - Country:US
Mailing Address - Phone:713-652-3065
Mailing Address - Fax:713-652-2717
Practice Address - Street 1:1315 ST JOSEPH PKWY
Practice Address - Street 2:SUITE 1106
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8233
Practice Address - Country:US
Practice Address - Phone:713-652-3065
Practice Address - Fax:713-652-2717
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2010-11-08
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
TXE6293174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035322901Medicaid
TXD83793Medicare UPIN
TX00PB49Medicare PIN