Provider Demographics
NPI:1952335903
Name:MARCO A. RENAZCO, M.D., P.A.
Entity Type:Organization
Organization Name:MARCO A. RENAZCO, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:RENAZCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-599-3313
Mailing Address - Street 1:707 S FRY RD
Mailing Address - Street 2:SUITE 465
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2256
Mailing Address - Country:US
Mailing Address - Phone:281-599-3313
Mailing Address - Fax:281-599-3363
Practice Address - Street 1:707 S FRY RD
Practice Address - Street 2:SUITE 465
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2256
Practice Address - Country:US
Practice Address - Phone:281-599-3313
Practice Address - Fax:281-599-3363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL19762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F0611Medicare ID - Type UnspecifiedPSYCHIATRIST/M.D.