Provider Demographics
NPI:1134181621
Name:KRAMER, JONATHAN D (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:D
Last Name:KRAMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 E IDAHO ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6267
Mailing Address - Country:US
Mailing Address - Phone:208-344-4900
Mailing Address - Fax:208-385-7811
Practice Address - Street 1:100 E IDAHO ST
Practice Address - Street 2:SUITE 301
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6267
Practice Address - Country:US
Practice Address - Phone:208-344-4900
Practice Address - Fax:208-385-7811
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM8315208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1104429Medicare ID - Type UnspecifiedMEDICARE #
IDG64281Medicare UPIN