Provider Demographics
NPI:1740358225
Name:RENTON, PAUL N JR (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:N
Last Name:RENTON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 BROOK AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-4209
Mailing Address - Country:US
Mailing Address - Phone:940-766-0217
Mailing Address - Fax:940-766-0730
Practice Address - Street 1:808 BROOK AVE
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4209
Practice Address - Country:US
Practice Address - Phone:940-766-0217
Practice Address - Fax:940-766-0730
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG83682085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123825OtherSUPERIOR HEALTHPLAN
TXA003OtherHUMANA MILITARY HEALTHPLA
TXMDG8368OtherWORKERS COMPENSATION
TX81R704OtherBLUE CROSS BLUE SHIELD
TXMDG8368OtherWORKERS COMPENSATION
TXE79448Medicare UPIN