Provider Demographics
NPI:1629034673
Name:RENUART, DANIEL ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ROBERT
Last Name:RENUART
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 1:900 INGRAHAM AVE
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-4336
Mailing Address - Country:US
Mailing Address - Phone:863-421-6565
Mailing Address - Fax:863-421-7474
Practice Address - Street 1:900 INGRAHAM AVE
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-4336
Practice Address - Country:US
Practice Address - Phone:863-421-6565
Practice Address - Fax:863-421-7474
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 70353208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269334OtherAVMED #
FL32418OtherBLUE CROSS/BLUE SHIELD #
FL258114100Medicaid
FL7557370OtherCIGNA #