Provider Demographics
NPI:1326087339
Name:RENNER, JERE MICHEAL (DO)
Entity Type:Individual
Prefix:
First Name:JERE
Middle Name:MICHEAL
Last Name:RENNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 SANDY RIVER RD
Mailing Address - Street 2:
Mailing Address - City:NEW SHARON
Mailing Address - State:ME
Mailing Address - Zip Code:04955-3312
Mailing Address - Country:US
Mailing Address - Phone:207-778-9798
Mailing Address - Fax:
Practice Address - Street 1:1 VA CTR
Practice Address - Street 2:
Practice Address - City:TOGUS
Practice Address - State:ME
Practice Address - Zip Code:04330-6719
Practice Address - Country:US
Practice Address - Phone:207-623-8411
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1640207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine