Healthcare Provider Details

I. General information

NPI: 1780893008
Provider Name (Legal Business Name): JOHN P RENTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 NE MARY ROSE PL STE 120
BEND OR
97701-7132
US

IV. Provider business mailing address

2450 NE MARY ROSE PL STE 120
BEND OR
97701-7132
US

V. Phone/Fax

Practice location:
  • Phone: 541-312-6784
  • Fax: 541-312-7057
Mailing address:
  • Phone: 541-312-6784
  • Fax: 541-312-7057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number151280
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: