Provider Demographics
NPI:1437132883
Name:CRAM, PETER M (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:M
Last Name:CRAM
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:PO BOX 650859 DEPT 710
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265
Mailing Address - Country:US
Mailing Address - Phone:409-772-2222
Mailing Address - Fax:409-772-1084
Practice Address - Street 1:400 HARBORSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-1009
Practice Address - Country:US
Practice Address - Phone:409-747-1883
Practice Address - Fax:409-747-7012
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34857207R00000X
TXT1337207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0279729Medicaid
IA59574OtherWELLMARK BCBS
IA110243718Medicare PIN
IA59574OtherWELLMARK BCBS
IA0279729Medicaid