Provider Demographics
NPI:1194820621
Name:STOCK, RENEE C (DO)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:C
Last Name:STOCK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12720 HILLCREST RD STE 625
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2163
Mailing Address - Country:US
Mailing Address - Phone:469-830-9600
Mailing Address - Fax:469-830-9601
Practice Address - Street 1:12720 HILLCREST RD STE 625
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2163
Practice Address - Country:US
Practice Address - Phone:469-830-9600
Practice Address - Fax:469-830-9601
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3844207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151919103Medicaid
TX8D3919Medicare ID - Type Unspecified