Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 847025 | WI |
NPI | 1356378145 |
---|---|
Provider Name | Dr. John Julian Renard |
First Address | Appleton, WI 54915 |
Second Address | Appleton, WI 54915 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 03/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U90564 | (02) | WI |