Provider Demographics
NPI:1336151067
Name:KRAMER, BRADLEY A (PAC)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:A
Last Name:KRAMER
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-434-9200
Mailing Address - Fax:321-951-7408
Practice Address - Street 1:8725 N WICKHAM RD STE 301
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2240
Practice Address - Country:US
Practice Address - Phone:321-434-9200
Practice Address - Fax:321-434-9202
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105773363AS0400X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016566100Medicaid
FLDY106YOtherMEDICARE
WI42992800Medicaid
P06505Medicare UPIN
WI023407650Medicare ID - Type Unspecified