Provider Demographics
NPI:1013938042
Name:LARAMIE, JEANNINE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANNINE
Middle Name:
Last Name:LARAMIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 E ALLUVIAL AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3832
Mailing Address - Country:US
Mailing Address - Phone:559-900-7048
Mailing Address - Fax:559-765-4252
Practice Address - Street 1:1515 E ALLUVIAL AVE STE 103
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3832
Practice Address - Country:US
Practice Address - Phone:559-900-7048
Practice Address - Fax:559-765-4252
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61150207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG72885Medicare UPIN