MEDICARE: RONALD LESLIE RENNICK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QS1000X	Student Health Clinic/Center	10449	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	930026495	OTHER	OR	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114998309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD LESLIE RENNICK M.D.

Provider Business Mailing Address
First Line	:	1232 UNIVERSITY OF OREGON
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97403-1205
Country	:	US
Telephone Number	:	541-346-0565
Fax Number	:	541-346-2748

Provider Business Practice Location Address
First Line	:	1232 UNIVERSITY OF OREGON
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97403-1232
Country	:	US
Telephone Number	:	541-346-0565
Fax Number	:	541-346-2748

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	12/11/2012

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