Provider Demographics
NPI:1952336232
Name:HOWARD, RENEE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:MARIE
Last Name:HOWARD
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 1:5000 CIVIC CENTER DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-4184
Mailing Address - Country:US
Mailing Address - Phone:415-499-0100
Mailing Address - Fax:415-499-0290
Practice Address - Street 1:5000 CIVIC CENTER DR
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-4184
Practice Address - Country:US
Practice Address - Phone:415-499-0100
Practice Address - Fax:415-499-0290
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56625207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG56625OtherLICENSE
CA00G566254Medicare PIN