Provider Demographics
NPI:1881007839
Name:RENER, DONALD RAY SR
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:RAY
Last Name:RENER
Suffix:SR
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 1:417 ROBERTSON ST
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-4339
Mailing Address - Country:US
Mailing Address - Phone:337-256-9790
Mailing Address - Fax:
Practice Address - Street 1:417 ROBERTSON ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-4339
Practice Address - Country:US
Practice Address - Phone:337-256-9790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-07
Last Update Date:2014-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA821590347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle