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General NPI Number Information
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NPI Number | 1649385386
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Entity Type | Individual
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Provider Name | MARK B RENCHER MD
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Gender | Male
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 10/20/2008
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Provider Practice Location Address
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Address Line | 2610 CHANNING WAY
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City | IDAHO FALLS
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State | ID
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Zip | 83404
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Country | US
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Telephone | 208-523-0888
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Fax | 208-523-0968
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Provider Business Mailing Address
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Address Line | 1751 REVERE WAY
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City | EAGLE MOUNTAIN
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State | UT
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Zip | 84005-5147
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Country | US
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Telephone | 801-995-1951
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Fax | 801-995-1951
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | M4486
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License Number State | ID
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