Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 1640 | ME |
NPI | 1326087339 |
---|---|
Provider Name | Jere Micheal Renner |
First Address | New Sharon, ME 04955-3312 |
Second Address | Togus, ME 04330-6719 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 08/07/2007 |