Individual
MARK B RENCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2610 CHANNING WAY, IDAHO FALLS, ID 83404
(208) 523-0888
(208) 523-0968
Mailing address
1751 REVERE WAY, EAGLE MOUNTAIN, UT 84005-5147
(801) 995-1951
(801) 995-1951
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M4486
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010000652
BLUE SHIELD
ID
05
—
002543500
—
ID
01
—
44867
BLUE CROSS
ID
Enumeration date
08/21/2006
Last updated
10/20/2008
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