Provider Demographics
NPI:1598926479
Name:EDWARD L. KRAMER, D.O., P.A.
Entity Type:Organization
Organization Name:EDWARD L. KRAMER, D.O., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:DO , PA
Authorized Official - Phone:817-731-4070
Mailing Address - Street 1:4916 CAMP BOWIE BLVD
Mailing Address - Street 2:108
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-4196
Mailing Address - Country:US
Mailing Address - Phone:817-731-4070
Mailing Address - Fax:817-731-4155
Practice Address - Street 1:4916 CAMP BOWIE BLVD
Practice Address - Street 2:108
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-4196
Practice Address - Country:US
Practice Address - Phone:817-731-4070
Practice Address - Fax:817-731-4155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ70382084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00640ZOtherPTAN