Provider Demographics
NPI:1811523715
Name:RENOUARD, BRYSON J
Entity type:Individual
Prefix:
First Name:BRYSON
Middle Name:J
Last Name:RENOUARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 RUTHIE RUN
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7155
Mailing Address - Country:US
Mailing Address - Phone:425-879-3188
Mailing Address - Fax:
Practice Address - Street 1:1441 E DAWN DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-2702
Practice Address - Country:US
Practice Address - Phone:425-879-3188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-23
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU4613207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine