Provider Demographics
NPI:1700469814
Name:CRAMER, GREGORY ROBERT
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:ROBERT
Last Name:CRAMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N 12TH ST
Mailing Address - Street 2:APT 1805
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602
Mailing Address - Country:US
Mailing Address - Phone:814-251-2501
Mailing Address - Fax:
Practice Address - Street 1:3100 E FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4613
Practice Address - Country:US
Practice Address - Phone:814-251-2501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9116628363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant