Healthcare Provider Details

I. General information

NPI: 1942244389
Provider Name (Legal Business Name): DAVID HONGWEI REN MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7330 FERN AVE
SHREVEPORT LA
71105-4938
US

IV. Provider business mailing address

1058 WATERS EDGE CIR
SHREVEPORT LA
71106-7776
US

V. Phone/Fax

Practice location:
  • Phone: 318-798-6614
  • Fax: 318-798-3322
Mailing address:
  • Phone: 318-798-9984
  • Fax: 318-798-3322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number14570R
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberM3070
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberE-5887
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: