Provider Demographics
NPI:1295843092
Name:RENBAUM, JOEL WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:WILLIAM
Last Name:RENBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DANIEL BURNHAM CT
Mailing Address - Street 2:SUITE 365C
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-5455
Mailing Address - Country:US
Mailing Address - Phone:415-409-7364
Mailing Address - Fax:415-409-0735
Practice Address - Street 1:1 DANIEL BURNHAM CT
Practice Address - Street 2:SUITE 365C
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5455
Practice Address - Country:US
Practice Address - Phone:415-409-7364
Practice Address - Fax:415-409-0735
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG17949174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA40232Medicare UPIN