Healthcare Provider Details

I. General information

NPI: 1235143736
Provider Name (Legal Business Name): GARY ALAN GRAMM DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 08/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6135 KING ROAD SUITE A
LOOMIS CA
95650-8877
US

IV. Provider business mailing address

6135 KING ROAD SUITE A
LOOMIS CA
95650-8877
US

V. Phone/Fax

Practice location:
  • Phone: 916-652-0427
  • Fax: 916-652-4197
Mailing address:
  • Phone: 916-652-0427
  • Fax: 916-652-4197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A4617
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: