Basic Information
| Provider Information | |||||||||
| NPI: | 1376646596 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRAMER | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | HARRIS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1773 W ST MARYS RD | ||||||||
| Address2: | 201 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206170971 | ||||||||
| FaxNumber: | 5208828973 | ||||||||
| Practice Location | |||||||||
| Address1: | 1773 W ST MARYS RD | ||||||||
| Address2: | STE 201 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206170971 | ||||||||
| FaxNumber: | 5208828973 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 07168 | AZ | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 268442 | 05 | AZ | MEDICAID |