MEDICARE: DR. CHARLES JOSEPH RENNER 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	207Q00000X	Family Medicine Physician	G67128	CA

General Provider Information

NPI Number	:	1669439733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES JOSEPH RENNER M.D.

Provider Business Mailing Address
First Line	:	1450 TREAT BLVD # 300
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94597-2168
Country	:	US
Telephone Number	:	925-952-2888
Fax Number	:

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

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

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	11/05/2018

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