Healthcare Provider Details

I. General information

NPI: 1134181621
Provider Name (Legal Business Name): JONATHAN D KRAMER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E IDAHO ST SUITE 301
BOISE ID
83712-6267
US

IV. Provider business mailing address

100 E IDAHO ST SUITE 301
BOISE ID
83712-6267
US

V. Phone/Fax

Practice location:
  • Phone: 208-344-4900
  • Fax: 208-385-7811
Mailing address:
  • Phone: 208-344-4900
  • Fax: 208-385-7811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberM8315
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: