Basic Information
| Provider Information | |||||||||
| NPI: | 1023191608 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RENNELS | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7822 DAVENPORT ST | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681143629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023914855 | ||||||||
| FaxNumber: | 4023916818 | ||||||||
| Practice Location | |||||||||
| Address1: | 7822 DAVENPORT ST | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681143629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023914855 | ||||||||
| FaxNumber: | 4023916818 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 10/28/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 17292 | NE | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 050024929 | 01 | RR MEDICARE | OTHER | 088553 | 01 | MEDICARE | OTHER |