MEDICARE: EDEE RENIER DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	PO61449695	WA
2	213ES0103X	Foot & Ankle Surgery Podiatrist	PL61082175	WA

General Provider Information

NPI Number	:	1215590997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDEE RENIER DPM

Provider Business Mailing Address
First Line	:	6016 ADDISON RD SW
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98367-1006
Country	:	US
Telephone Number	:	831-421-1564
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 BOONE RD
Second Line	:
City	:	BREMERTON
State	:	WA
Zip	:	98312-1894
Country	:	US
Telephone Number	:	360-475-4000
Fax Number	:

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

Provider Enumeration Date	:	04/17/2019
Last Update Date	:	06/01/2026

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Directions to “ EDEE RENIER DPM” Practice Location

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