Organization
DANIEL R. RENUART, M.D., P.A.
Active
Other names
RAILROAD PARK PEDIATRICS AND FOUR CORNERS PEDIATRICS
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL ROBERT RENUART M.D. (PRESIDENT)
(863) 421-6565
Entity
Organization
Contact information
Practice address
900 INGRAHAM AVE, HAINES CITY, FL 33844-4336
(863) 421-6565
(863) 421-7474
Mailing address
900 INGRAHAM AVE, HAINES CITY, FL 33844-4336
(863) 421-6565
(863) 421-7474
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME70353
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
272383200
—
FL
05
—
272383201
—
FL
01
—
74525
BLUE CROSS BLUE SHIELD #
FL
Enumeration date
04/24/2006
Last updated
10/19/2011
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