Provider Demographics
NPI:1669416954
Name:BOBROWSKI, RENEE A (MD)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:A
Last Name:BOBROWSKI
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 1:900 N LIBERTY ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8704
Mailing Address - Country:US
Mailing Address - Phone:208-367-5544
Mailing Address - Fax:208-367-5543
Practice Address - Street 1:900 N LIBERTY ST
Practice Address - Street 2:SUITE 206
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8704
Practice Address - Country:US
Practice Address - Phone:208-367-5544
Practice Address - Fax:208-367-5543
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM9511207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1132230Medicare ID - Type Unspecified
F56313Medicare UPIN