Healthcare Provider Details

I. General information

NPI: 1568447662
Provider Name (Legal Business Name): GEORGE GRAMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 STOCKTON BLVD
SACRAMENTO CA
95817-1419
US

IV. Provider business mailing address

2230 STOCKTON BLVD
SACRAMENTO CA
95817-1419
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-7814
  • Fax:
Mailing address:
  • Phone: 916-734-7814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberC036563
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: