Individual
JEREMY JACKSON RENZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1821 S WEBSTER AVE, GREEN BAY, WI 54301-2253
(920) 496-4700
Mailing address
PO BOX 19070, GREEN BAY, WI 54307-9070
(920) 496-4700
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
DR.0066106
CO
207RP1001X
Pulmonary Disease Physician
Primary
81579-21
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100288803
—
WI
Enumeration date
04/16/2018
Last updated
09/25/2024
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