Individual
DR. JAMES A DIRENNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2101 CORONA RD STE 102, COLUMBIA, MO 65203-2582
(573) 234-1800
Mailing address
2101 CORONA RD, STE 102, COLUMBIA, MO 65203-2582
(573) 607-4618
(573) 234-1799
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R6C32
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09561143
BLUECROSS/BLUE SHIELD KC
MO
01
—
10001696500
COMMUNITY HEALTH PLAN
MO
05
—
200301660A
—
KS
05
—
246807846
—
MO
01
—
26D0896653
CLIA
MO
01
—
4001425
AETNA
MS
Enumeration date
07/17/2006
Last updated
07/21/2023
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