Provider Demographics
NPI:1952413502
Name:GRAMER, RICHARD L (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:GRAMER
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 1:411 N 6TH ST
Mailing Address - Street 2:#4466
Mailing Address - City:EMERY
Mailing Address - State:SD
Mailing Address - Zip Code:57332-2124
Mailing Address - Country:US
Mailing Address - Phone:970-778-0885
Mailing Address - Fax:
Practice Address - Street 1:411 N 6TH ST
Practice Address - Street 2:#4466
Practice Address - City:EMERY
Practice Address - State:SD
Practice Address - Zip Code:57332-2124
Practice Address - Country:US
Practice Address - Phone:970-778-0885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57631207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063332100Medicaid
FL10641OtherBCBS
FL063332100Medicaid
FLE41532Medicare UPIN