Provider Demographics
NPI:1194736884
Name:DERENONCOURT, FRANTZ J SR (MD)
Entity type:Individual
Prefix:DR
First Name:FRANTZ
Middle Name:J
Last Name:DERENONCOURT
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:655 EUCLID AVENUE
Mailing Address - Street 2:SUITE 405
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950
Mailing Address - Country:US
Mailing Address - Phone:619-267-2910
Mailing Address - Fax:619-267-7786
Practice Address - Street 1:655 EUCLID AVENUE
Practice Address - Street 2:SUITE 405
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950
Practice Address - Country:US
Practice Address - Phone:619-267-2910
Practice Address - Fax:619-267-7786
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54662208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G546621Medicaid
CAG54662AMedicare ID - Type Unspecified
A93312Medicare UPIN