Provider Demographics
NPI:1235143736
Name:GRAMM, GARY ALAN (DO)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:ALAN
Last Name:GRAMM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6135 KING ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LOOMIS
Mailing Address - State:CA
Mailing Address - Zip Code:95650-8877
Mailing Address - Country:US
Mailing Address - Phone:916-652-0427
Mailing Address - Fax:916-652-4197
Practice Address - Street 1:6135 KING ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:LOOMIS
Practice Address - State:CA
Practice Address - Zip Code:95650-8877
Practice Address - Country:US
Practice Address - Phone:916-652-0427
Practice Address - Fax:916-652-4197
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A4617207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0985590001OtherDME
15202-1OtherFAA
CAGR0017780Medicaid
52458OtherRR MEDICARE
CAGR0017780Medicaid
ZZZ94479ZMedicare UPIN