Healthcare Provider Details

I. General information

NPI: 1487192274
Provider Name (Legal Business Name): CRAIG ALLAN CRAMER HAS TRAINEE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2017
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 S PLUMOSA ST STE D
MERRITT ISLAND FL
32952-3567
US

IV. Provider business mailing address

1751 BLUE RIDGE RD
WINTER PARK FL
32789-5826
US

V. Phone/Fax

Practice location:
  • Phone: 321-453-7800
  • Fax: 321-453-7801
Mailing address:
  • Phone: 407-601-5798
  • Fax: 407-286-3186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAST619
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: