Provider Demographics
NPI:1457327058
Name:KREMSER, PAUL C (MD)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:C
Last Name:KREMSER
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 1:2700 NW STEWART PARKWAY
Mailing Address - Street 2:STE 200
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470
Mailing Address - Country:US
Mailing Address - Phone:541-677-1555
Mailing Address - Fax:541-677-6543
Practice Address - Street 1:489 CHEROKEE AVE
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-9534
Practice Address - Country:US
Practice Address - Phone:541-673-2146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD15182208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR148296Medicaid
R114989Medicare ID - Type Unspecified
OR148296Medicaid