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General NPI Number Information
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NPI Number | 1700216488
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Entity Type | Organization
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Legal Business Name | WALTER D BRAMSON MD A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 11/18/2013
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Last Update Date | 06/13/2014
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Provider Practice Location Address
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Address Line | 580 FOREST SHADE RD UNIT 1
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City | CRESTLINE
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State | CA
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Zip | 92325-3816
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Country | US
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Telephone | 909-338-1851
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Fax | 909-338-6381
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Provider Business Mailing Address
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Address Line | PO BOX 3816 580 FOREST SHADE RD UNIT 1
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City | CRESTLINE
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State | CA
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Zip | 92325-3816
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Country | US
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Telephone | 909-338-1851
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Fax | 909-338-6381
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Authorized Official
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Title or Position | PRESIDENT
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Name | WALTER DAVID BRAMSON
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Credential | MD
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Telephone | 909-338-1851
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | G40647
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License Number State | CA
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