Provider Demographics
NPI:1184653941
Name:OFFNER, JEANMAIRE RENE (MD)
Entity type:Individual
Prefix:
First Name:JEANMAIRE
Middle Name:RENE
Last Name:OFFNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 E. NIZHONI BLVD
Mailing Address - Street 2:BOX 1337
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-1337
Mailing Address - Country:US
Mailing Address - Phone:505-722-1262
Mailing Address - Fax:505-726-8557
Practice Address - Street 1:516 E. NIZHONI BLVD
Practice Address - Street 2:BOX 1337
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-1337
Practice Address - Country:US
Practice Address - Phone:505-722-1262
Practice Address - Fax:505-726-8557
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR-30024207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ889941Medicaid
NM89526350Medicaid
TX8HD229Medicare ID - Type UnspecifiedHSZ003
TX8HD227Medicare ID - Type UnspecifiedHSZ197
TX8HD228Medicare ID - Type UnspecifiedHSZ002
NM89526350Medicaid
E58985Medicare UPIN
TX8HD230Medicare ID - Type UnspecifiedHSZ005
TX8HC851Medicare ID - Type UnspecifiedHSZ006