Provider Demographics
NPI:1467414177
Name:EWING, RENEE D (MD)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:D
Last Name:EWING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 N MERAMEC AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3745
Mailing Address - Country:US
Mailing Address - Phone:314-726-1150
Mailing Address - Fax:314-726-1152
Practice Address - Street 1:211 N MERAMEC AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-3745
Practice Address - Country:US
Practice Address - Phone:314-726-1150
Practice Address - Fax:314-726-1152
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3N58207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO112611OtherBLUE CROSS/BLUE SHIELD
MO20956805Medicaid
MOMA4297002Medicare PIN
MO112611OtherBLUE CROSS/BLUE SHIELD
MO20956805Medicaid