Provider Demographics
NPI:1437556644
Name:RONALD L. RENARD MD, INC.
Entity Type:Organization
Organization Name:RONALD L. RENARD MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:RENARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-226-5325
Mailing Address - Street 1:1505 VICTOR AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-4031
Mailing Address - Country:US
Mailing Address - Phone:530-226-5325
Mailing Address - Fax:530-226-5367
Practice Address - Street 1:1505 VICTOR AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-4031
Practice Address - Country:US
Practice Address - Phone:530-226-5325
Practice Address - Fax:530-226-5367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG36415207K00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA030000564OtherRAILROAD PROVIDER NUMBER
CA00G364150OtherMEDICARE PROVIDER NUMBER
CAA46680Medicare UPIN