Healthcare Provider Details

I. General information

NPI: 1356490916
Provider Name (Legal Business Name): JESSE M. KRAMER, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2128 EUREKA WAY
REDDING CA
96001-0427
US

IV. Provider business mailing address

2128 EUREKA WAY
REDDING CA
96001-0427
US

V. Phone/Fax

Practice location:
  • Phone: 530-246-9736
  • Fax: 530-246-4052
Mailing address:
  • Phone: 530-246-9736
  • Fax: 530-246-4052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. JESSE MAX KRAMER
Title or Position: ADMINISTRATOR
Credential: M.D.
Phone: 530-246-9736