Healthcare Provider Details

I. General information

NPI: 1073864484
Provider Name (Legal Business Name): WARREN G. KRAMER, III, M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2012
Last Update Date: 09/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 AVOCADO AVE SUITE 307
NEWPORT BEACH CA
92660-7720
US

IV. Provider business mailing address

1401 AVOCADO AVE SUITE 307
NEWPORT BEACH CA
92660-7720
US

V. Phone/Fax

Practice location:
  • Phone: 949-720-1944
  • Fax: 949-720-9710
Mailing address:
  • Phone: 949-720-1944
  • Fax: 949-720-9710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberG59225
License Number StateCA

VIII. Authorized Official

Name: DR. WARREN G. KRAMER III
Title or Position: PRESIDENT
Credential: M.D.
Phone: 949-720-1944