Healthcare Provider Details

I. General information

NPI: 1689134611
Provider Name (Legal Business Name): RANJOT BASRAM DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

582 E HARDING WAY
STOCKTON CA
95204-6110
US

IV. Provider business mailing address

582 E HARDING WAY
STOCKTON CA
95204-6110
US

V. Phone/Fax

Practice location:
  • Phone: 209-442-6851
  • Fax: 844-226-9193
Mailing address:
  • Phone: 209-442-6851
  • Fax: 844-226-9193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A19577
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: