Healthcare Provider Details

I. General information

NPI: 1770539306
Provider Name (Legal Business Name): THOMAS H. RENARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 05/08/2020
Certification Date: 05/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 PARK CENTRAL DR STE 400
DALLAS TX
75251-2116
US

IV. Provider business mailing address

12200 PARK CENTRAL DR STE 400
DALLAS TX
75251-2116
US

V. Phone/Fax

Practice location:
  • Phone: 214-483-9300
  • Fax: 214-483-9301
Mailing address:
  • Phone: 214-483-9300
  • Fax: 214-483-9301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberH2719
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: