Provider Demographics
NPI:1215921614
Name:RENTON, GEORGE SCOTT (DO)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:SCOTT
Last Name:RENTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:957 BROOKHAVEN CT
Mailing Address - Street 2:BUILDING E STE 3 & 4
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-3890
Mailing Address - Country:US
Mailing Address - Phone:231-777-5906
Mailing Address - Fax:231-773-8904
Practice Address - Street 1:957 BROOOKHAVEN CT
Practice Address - Street 2:BUILDING E SUITE 3 & 4
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-3886
Practice Address - Country:US
Practice Address - Phone:231-777-5906
Practice Address - Fax:231-773-8904
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101007424207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2720950-11Medicaid
MI0F16049Medicare ID - Type Unspecified
MI2720950-11Medicaid