Provider Demographics
NPI:1538110606
Name:DUBOIS, RENATO (MD)
Entity Type:Individual
Prefix:DR
First Name:RENATO
Middle Name:
Last Name:DUBOIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5325 GREENWOOD AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2452
Mailing Address - Country:US
Mailing Address - Phone:561-844-9858
Mailing Address - Fax:561-844-3436
Practice Address - Street 1:5325 GREENWOOD AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2452
Practice Address - Country:US
Practice Address - Phone:561-844-9858
Practice Address - Fax:561-844-3436
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME-00552592080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL037646900Medicaid
FL037646900Medicaid