Provider Demographics
NPI:1164478467
Name:RENAUD, TROY (DO)
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:
Last Name:RENAUD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 HIGHWAY 218 N
Mailing Address - Street 2:
Mailing Address - City:LA PORTE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50651-1012
Mailing Address - Country:US
Mailing Address - Phone:319-342-2131
Mailing Address - Fax:319-342-3200
Practice Address - Street 1:601 HIGHWAY 218 N
Practice Address - Street 2:
Practice Address - City:LA PORTE CITY
Practice Address - State:IA
Practice Address - Zip Code:50651
Practice Address - Country:US
Practice Address - Phone:319-342-2131
Practice Address - Fax:319-342-3200
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03088207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA59956OtherBLUE CROSS/BLUE SHIELD
IA6155424Medicaid
IA59956OtherBLUE CROSS/BLUE SHIELD
IA59956Medicare PIN