Healthcare Provider Details

I. General information

NPI: 1851336440
Provider Name (Legal Business Name): JAN J KRAEMER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 09/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 AVE DOMENECH
SAN JUAN PR
00918-3511
US

IV. Provider business mailing address

35 CALLE JUAN C BORBON STE 67-333
GUAYNABO PR
00969-5374
US

V. Phone/Fax

Practice location:
  • Phone: 787-675-0050
  • Fax: 888-664-2337
Mailing address:
  • Phone: 787-239-9377
  • Fax: 888-664-2337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number227383
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number227383
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: