Provider Demographics
NPI:1992749329
Name:KRAMER, EDWARD LOVETT (DO)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:LOVETT
Last Name:KRAMER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 1:1 MERCY LN STE 505
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6462
Practice Address - Country:US
Practice Address - Phone:501-623-2781
Practice Address - Fax:501-623-2405
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ70382084N0400X, 208100000X
ARE-108192084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113719204Medicaid
TX8U7183OtherBCBS
TXE82042Medicare UPIN
TX8G6276Medicare PIN