Healthcare Provider Details

I. General information

NPI: 1164644092
Provider Name (Legal Business Name): REGINA-MARIA RENNER M.D, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 SW SAM JACKSON PARK RD OHSU DEPARTMENT OF OB&GYN
PORTLAND OR
97239-3011
US

IV. Provider business mailing address

3181 SW SAM JACKSON PARK RD DEPARTMENT OF OB&GYN
PORTLAND OR
97239-3011
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-9000
  • Fax:
Mailing address:
  • Phone: 503-380-3523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberLL17047
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: