Provider Demographics
NPI:1740245091
Name:RENN, JOHN THOMAS
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:THOMAS
Last Name:RENN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 AOLOA PL
Mailing Address - Street 2:APT 420
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-5226
Mailing Address - Country:US
Mailing Address - Phone:808-386-7540
Mailing Address - Fax:808-474-7806
Practice Address - Street 1:250 MAKALAPA DR
Practice Address - Street 2:
Practice Address - City:PEARL HARBOR
Practice Address - State:HI
Practice Address - Zip Code:96860-3131
Practice Address - Country:US
Practice Address - Phone:808-474-5428
Practice Address - Fax:808-474-7806
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman