Provider Demographics
NPI:1871518761
Name:BUDHRAM, HAROLD S (MD)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:S
Last Name:BUDHRAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5145 SHASTA DAM BLVD
Mailing Address - Street 2:
Mailing Address - City:SHASTA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:96019-9403
Mailing Address - Country:US
Mailing Address - Phone:530-275-5421
Mailing Address - Fax:530-275-1549
Practice Address - Street 1:5145 SHASTA DAM BLVD
Practice Address - Street 2:
Practice Address - City:SHASTA LAKE
Practice Address - State:CA
Practice Address - Zip Code:96019-9403
Practice Address - Country:US
Practice Address - Phone:530-275-5421
Practice Address - Fax:530-275-5156
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG31973207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG31973OtherSTATE ID
CARHM53954FMedicaid
CA68-0188060OtherTAX ID#
CA68-0188060OtherTAX ID#
CAG31973OtherSTATE ID
CAA44939Medicare UPIN