Provider Demographics
NPI:1902882434
Name:SCOTT, RENARD GARCIA (HS)
Entity Type:Individual
Prefix:MR
First Name:RENARD
Middle Name:GARCIA
Last Name:SCOTT
Suffix:
Gender:M
Credentials:HS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 COAST GUARD BLVD
Mailing Address - Street 2:MEDICAL DIVISION
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-2135
Mailing Address - Country:US
Mailing Address - Phone:757-483-8597
Mailing Address - Fax:757-483-8610
Practice Address - Street 1:4000 COAST GUARD BLVD
Practice Address - Street 2:MEDICAL DIVISION
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-2135
Practice Address - Country:US
Practice Address - Phone:757-483-8597
Practice Address - Fax:757-483-8610
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider