Provider Demographics
NPI:1205937026
Name:RENNER, JOHN ARTHUR JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ARTHUR
Last Name:RENNER
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:11 BRADDOCK PARK
Mailing Address - Street 2:UNIT A
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-5816
Mailing Address - Country:US
Mailing Address - Phone:617-267-8816
Mailing Address - Fax:
Practice Address - Street 1:251 CAUSEWAY ST
Practice Address - Street 2:VA OUTPATIENT CLINIC
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2148
Practice Address - Country:US
Practice Address - Phone:617-248-1022
Practice Address - Fax:617-248-1121
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MA293712084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry