Individual
MATTHEW D RENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 E IDAHO ST, SUITE 400, BOISE, ID 83712-6267
(208) 345-5250
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
MD155496
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1174787097
—
ID
05
—
19627874
—
CO
Enumeration date
07/10/2008
Last updated
09/05/2014
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