Provider Demographics
NPI:1407829435
Name:KREMER, JOHN A II (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:KREMER
Suffix:II
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:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:CHELAN
Mailing Address - State:WA
Mailing Address - Zip Code:98816-0368
Mailing Address - Country:US
Mailing Address - Phone:509-682-2511
Mailing Address - Fax:186-639-7863
Practice Address - Street 1:219 E JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:CHELAN
Practice Address - State:WA
Practice Address - Zip Code:98816-9160
Practice Address - Country:US
Practice Address - Phone:509-682-2511
Practice Address - Fax:186-639-7863
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-10344207Q00000X
WAMD00017439207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1005545Medicaid
WA1005545Medicaid
WA503851Medicare Oscar/Certification