MEDICARE: CHARLES RENNER, MD

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	261QP2300X	Primary Care Clinic/Center	G67128	CA

General Provider Information

NPI Number	:	1598906968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES RENNER, MD

Provider Business Mailing Address
First Line	:	5161 CLAYTON RD
Second Line	:	SUITE C
City	:	CONCORD
State	:	CA
Zip	:	94521-3191
Country	:	US
Telephone Number	:	925-687-2200
Fax Number	:	925-689-5608

Provider Business Practice Location Address
First Line	:	5161 CLAYTON RD
Second Line	:	SUITE C
City	:	CONCORD
State	:	CA
Zip	:	94521-3191
Country	:	US
Telephone Number	:	925-687-2200
Fax Number	:	925-689-5608

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. CHARLES JOSEPH RENNER
Credential	:	M.D.
Telephone Number	:	925-687-2200

Provider Enumeration Date	:	03/16/2009
Last Update Date	:	03/16/2009

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