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General NPI Number Information
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NPI Number | 1346572468
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Entity Type | Organization
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Legal Business Name | HAROLD S. BUDHRAM, MD, INC.
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Dates
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Enumeration Date | 02/01/2010
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Last Update Date | 05/22/2012
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Provider Practice Location Address
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Address Line | 5145 SHASTA DAM BLVD
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City | SHASTA LAKE
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State | CA
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Zip | 96019-9403
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Country | US
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Telephone | 530-275-5421
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Fax | 530-275-5156
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Provider Business Mailing Address
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Address Line | 5145 SHASTA DAM BLVD
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City | SHASTA LAKE
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State | CA
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Zip | 96019-9403
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Country | US
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Telephone | 530-275-5421
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Fax | 530-275-5156
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HAROLD SHAMNARINE BUDHRAM
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Credential | M.D.
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Telephone | 530-275-5421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G319730
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License Number State | CA
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