Provider Demographics
NPI:1770624595
Name:RENNIE, SCOTT R (DO)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:R
Last Name:RENNIE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 LAKEPOINTE DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-6469
Mailing Address - Country:US
Mailing Address - Phone:800-835-2362
Mailing Address - Fax:
Practice Address - Street 1:1945 LAKEPOINTE DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-6469
Practice Address - Country:US
Practice Address - Phone:800-835-2362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-41901207Q00000X
GA82314207Q00000X
WI52-321207Q00000X
WV3394207Q00000X
CA20A9729207Q00000X
FLOS15828207Q00000X
TXS0543207Q00000X
AZ007964207Q00000X
MN65048207Q00000X
NY298086207Q00000X
IL036148831207Q00000X
VA0102205607207Q00000X
IN02005666A207Q00000X
NC2019-00471207Q00000X
WAOP00002006207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine