Provider Demographics
NPI:1851428494
Name:CULVER, RENNIE WYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:RENNIE
Middle Name:WYNN
Last Name:CULVER
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 1:4324 LOVELAND ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-4122
Mailing Address - Country:US
Mailing Address - Phone:504-455-9990
Mailing Address - Fax:504-455-5715
Practice Address - Street 1:4324 LOVELAND ST
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-4122
Practice Address - Country:US
Practice Address - Phone:504-455-9990
Practice Address - Fax:504-455-5715
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH00422084P0800X
LA0123782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA03589OtherBLUE CROSS PROVIDER NUMBE
LA51201Medicare ID - Type Unspecified
LAB62879Medicare UPIN