Provider Demographics
NPI:1942706650
Name:RENSCH, GAGE PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:GAGE
Middle Name:PATRICK
Last Name:RENSCH
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 1:16910 FRANCES ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-1750
Mailing Address - Country:US
Mailing Address - Phone:402-505-8777
Mailing Address - Fax:402-933-7767
Practice Address - Street 1:16910 FRANCES ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2398
Practice Address - Country:US
Practice Address - Phone:402-505-8777
Practice Address - Fax:402-933-7767
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0406390200000X
NE34596207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
490466211OtherPASSPORT
NEH13221442OtherDRIVER'S LICENSE