Healthcare Provider Details

I. General information

NPI: 1295026862
Provider Name (Legal Business Name): RORY JOHN KAMERMAN-KRETZMER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RORY KRETZMER M.D.

II. Dates (important events)

Enumeration Date: 04/29/2011
Last Update Date: 08/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2516 STOCKTON BLVD
SACRAMENTO CA
95817
US

IV. Provider business mailing address

2516 STOCKTON BLVD
SACRAMENTO CA
95817-2208
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-5177
  • Fax:
Mailing address:
  • Phone: 916-734-5177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA123581
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberA123581
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: