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General NPI Number Information
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NPI Number | 1740611557
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Entity Type | Individual
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Provider Name | MATTHEW STEVEN RENNER PA-C
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Gender | Male
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Dates
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Enumeration Date | 12/03/2013
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 33100 CLEVELAND CLINIC BLVD
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City | AVON
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State | OH
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Zip | 44011-1390
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Country | US
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Telephone | 440-695-4000
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Fax | 440-695-4189
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Provider Business Mailing Address
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Address Line | PO BOX 3360
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City | PORTLAND
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State | OR
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Zip | 97208-3360
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Country | US
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Telephone |
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Fax |
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA60755013
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 50.007428RX
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License Number State | OH
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