Provider Demographics
NPI:1942244389
Name:REN, DAVID HONGWEI (MD, PHD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:HONGWEI
Last Name:REN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1058 WATERS EDGE CIR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-7776
Mailing Address - Country:US
Mailing Address - Phone:318-798-9984
Mailing Address - Fax:318-798-3322
Practice Address - Street 1:7330 FERN AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-4938
Practice Address - Country:US
Practice Address - Phone:318-798-6614
Practice Address - Fax:318-798-3322
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14570R207WX0107X
TXM3070207WX0107X
ARE-5887207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAI07742Medicare UPIN