Healthcare Provider Details

I. General information

NPI: 1669834867
Provider Name (Legal Business Name): DEXTER VINCENT RENEER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2016
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 FLEMINGSBURG RD STE A340
MOREHEAD KY
40351-1015
US

IV. Provider business mailing address

800 ROSE ST UK DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
LEXINGTON KY
40536-0298
US

V. Phone/Fax

Practice location:
  • Phone: 606-207-2931
  • Fax: 606-783-0964
Mailing address:
  • Phone: 859-218-1661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number62193
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number55106
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number62193
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: