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General NPI Number Information
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NPI Number | 1487792248
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Entity Type | Organization
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Legal Business Name | INTERNAL MEDICINE OF WALTERBORO
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 05/14/2013
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Provider Practice Location Address
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Address Line | 873 ROBERTSON BLVD
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City | WALTERBORO
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State | SC
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Zip | 29488
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Country | US
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Telephone | 843-542-9535
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Fax | 843-542-9675
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Provider Business Mailing Address
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Address Line | 873 ROBERTSON BLVD
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City | WALTERBORO
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State | SC
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Zip | 29488
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Country | US
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Telephone | 843-542-9535
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Fax | 843-542-9675
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Authorized Official
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Title or Position | OWNER
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Name | JEFFREY RAE KRAMER
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Credential | MD
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Telephone | 843-542-9535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 18426
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License Number State | SC
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