Provider Demographics
NPI:1497792436
Name:RENARD, RONALD L (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:L
Last Name:RENARD
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 1:1505 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG36415207K00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G364151Medicaid
CA030000564OtherRAILROAD PROVIDER NUMBER
CA030000564OtherRAILROAD PROVIDER NUMBER
CAA46680Medicare UPIN