Provider Demographics
NPI:1346201829
Name:RENSHAW, LOUIS R JR (PA)
Entity Type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:R
Last Name:RENSHAW
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8303 BLANTON STREET
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606
Mailing Address - Country:US
Mailing Address - Phone:352-686-3154
Mailing Address - Fax:352-688-2751
Practice Address - Street 1:8303 BLANTON STREET
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606
Practice Address - Country:US
Practice Address - Phone:352-686-3154
Practice Address - Fax:352-688-2751
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA1667363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00249789OtherRAILROAD MEDICARE
N190963OtherWELL CARE
FLU2078Medicare ID - Type Unspecified
FLS85283Medicare UPIN