Provider Demographics
NPI:1639170152
Name:KREMER, PAUL A (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:A
Last Name:KREMER
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 1:3260 NW VINTAGE WAY
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-6000
Mailing Address - Country:US
Mailing Address - Phone:360-698-9500
Mailing Address - Fax:360-698-9900
Practice Address - Street 1:3260 NW VINTAGE WAY
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-6000
Practice Address - Country:US
Practice Address - Phone:360-698-9500
Practice Address - Fax:360-698-9900
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00031039207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA180032891OtherRAIL ROAD MEDICARE
WA8148884Medicaid
WA45020OtherL&I
WAKR0057OtherREGENCE BCBS
WA911013662OtherPREMERA BCBS
F14017Medicare UPIN
G000201515Medicare ID - Type Unspecified
WA8148884Medicaid