Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 579 | NV |
N | 207Q00000X | Family Doctor | 579 | NV |
NPI | 1578717781 |
---|---|
Provider Name | Paul R Rennie |
First Address | Pasadena, CA 91199-0001 |
Second Address | Henderson, NV 89014-8800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2008 |
Last Update Date | 28/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D46528 | (02) | NV |