Provider Demographics
NPI:1952381295
Name:KRAMER, LAWRENCE E (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:E
Last Name:KRAMER
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 1:4343 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5338
Mailing Address - Country:US
Mailing Address - Phone:026-223-1711
Mailing Address - Fax:602-780-0881
Practice Address - Street 1:4343 N 16TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5338
Practice Address - Country:US
Practice Address - Phone:026-223-1711
Practice Address - Fax:602-780-0881
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21710207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ080142098OtherRAILROAD MEDICARE
AZZ142917OtherMEDICARE PTAN
AZ163361Medicaid
AZ163361Medicaid
AZF75158Medicare UPIN
AZZ142917OtherMEDICARE PTAN