Provider Demographics
NPI:1548586399
Name:SHIAO, RENEE
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:SHIAO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:TRAMONTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4511 HOSPITAL ST
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39581-5336
Mailing Address - Country:US
Mailing Address - Phone:228-875-3033
Mailing Address - Fax:228-875-3989
Practice Address - Street 1:4511 HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-5336
Practice Address - Country:US
Practice Address - Phone:228-875-3033
Practice Address - Fax:228-875-3989
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.206297207R00000X
MS24438207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine