Provider Demographics
NPI:1245471838
Name:RENNARD, MARVIN (MD)
Entity type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:
Last Name:RENNARD
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 1:800 SO HANLEY RD
Mailing Address - Street 2:3A
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-2689
Mailing Address - Country:US
Mailing Address - Phone:314-727-1400
Mailing Address - Fax:314-727-3841
Practice Address - Street 1:800 S HANLEY RD APT 3A
Practice Address - Street 2:3A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-2689
Practice Address - Country:US
Practice Address - Phone:314-727-1400
Practice Address - Fax:314-727-3841
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002002110207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology