Provider Demographics
NPI:1972685907
Name:FORD, RENATA B (MD)
Entity Type:Individual
Prefix:
First Name:RENATA
Middle Name:B
Last Name:FORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 W IH 10 STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-2041
Mailing Address - Country:US
Mailing Address - Phone:210-519-5797
Mailing Address - Fax:210-579-7027
Practice Address - Street 1:6800 W IH 10 STE 200
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-2041
Practice Address - Country:US
Practice Address - Phone:210-519-5797
Practice Address - Fax:210-579-7027
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41383208600000X
NC2009-02088208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC15570OtherBCBS
TX183371701Medicaid
TX8L11127Medicare PIN