Provider Demographics
NPI:1578838942
Name:RENNER, OMER CLYDE JR (MD)
Entity type:Individual
Prefix:DR
First Name:OMER
Middle Name:CLYDE
Last Name:RENNER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1534 APPLEY DR
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-3305
Mailing Address - Country:US
Mailing Address - Phone:423-586-1141
Mailing Address - Fax:
Practice Address - Street 1:1534 APPLEY DR
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3305
Practice Address - Country:US
Practice Address - Phone:423-586-1141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-17
Last Update Date:2012-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000003999208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery