Healthcare Provider Details

I. General information

NPI: 1437556644
Provider Name (Legal Business Name): RONALD L. RENARD MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2014
Last Update Date: 12/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 VICTOR AVE
REDDING CA
96003-4031
US

IV. Provider business mailing address

1505 VICTOR AVE
REDDING CA
96003-4031
US

V. Phone/Fax

Practice location:
  • Phone: 530-226-5325
  • Fax: 530-226-5367
Mailing address:
  • Phone: 530-226-5325
  • Fax: 530-226-5367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberG36415
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG36415
License Number StateCA

VIII. Authorized Official

Name: DR. RONALD LEE RENARD
Title or Position: OWNER
Credential: M.D.
Phone: 530-226-5325