Organization
DANIEL R. RENUART, MD, PA
Active
Other names
Four Corners Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL ROBERT RENUART M.D. (PRESIDENT)
(863) 424-8966
Entity
Organization
Contact information
Practice address
2506 SAND MINE RD, DAVENPORT, FL 33897-3402
(863) 424-8966
(863) 424-8825
Mailing address
2506 SAND MINE RD, DAVENPORT, FL 33897-3402
(863) 424-8966
(863) 424-8825
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME70353
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
272383201
—
FL
Enumeration date
08/19/2006
Last updated
10/19/2011
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