Individual
LOGAN RAY RENCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
801 7TH AVE, FORT WORTH, TX 76104-2733
(682) 885-4095
(682) 885-7499
Mailing address
PO BOX 733784, DALLAS, TX 75373-3784
(682) 885-6483
(682) 885-3113
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
BP10036643
TX
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
P6899
TX
Other
Enumeration date
04/13/2010
Last updated
11/07/2022
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