Provider Demographics
NPI:1760537484
Name:AZAR, RENA A (MD PC FPMRS)
Entity Type:Individual
Prefix:DR
First Name:RENA
Middle Name:A
Last Name:AZAR
Suffix:
Gender:F
Credentials:MD PC FPMRS
Other - Prefix:DR
Other - First Name:RENA
Other - Middle Name:A
Other - Last Name:AZAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PC FPMRS
Mailing Address - Street 1:325 S CEDAR AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SOUTH PITTSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37380-1305
Mailing Address - Country:US
Mailing Address - Phone:423-837-5801
Mailing Address - Fax:423-837-5807
Practice Address - Street 1:325 S CEDAR AVE STE 2
Practice Address - Street 2:
Practice Address - City:SOUTH PITTSBURG
Practice Address - State:TN
Practice Address - Zip Code:37380-1322
Practice Address - Country:US
Practice Address - Phone:423-837-5801
Practice Address - Fax:423-837-5807
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30628207VG0400X
TNMD0000030628207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL891-08307OtherBCBS AL PROV #
TN62-1818059OtherTAX ID
TN3149771OtherBCBS TN PROV #
TN3149771OtherBCBS TN PROV #
TN3829222Medicare PIN