Provider Demographics
NPI:1811906894
Name:BUHARI, FRAM (MD)
Entity type:Individual
Prefix:DR
First Name:FRAM
Middle Name:
Last Name:BUHARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 N CALIFORNIA ST
Mailing Address - Street 2:STE 14
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-3757
Mailing Address - Country:US
Mailing Address - Phone:209-942-1005
Mailing Address - Fax:209-942-0455
Practice Address - Street 1:2800 N CALIFORNIA ST
Practice Address - Street 2:STE 14
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204
Practice Address - Country:US
Practice Address - Phone:209-464-7681
Practice Address - Fax:209-464-1647
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A299270207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A299270Medicaid
CA110088087OtherRAILROAD MEDICARE
00A299270Medicare ID - Type Unspecified
CA110088087OtherRAILROAD MEDICARE