Provider Demographics
NPI:1770640856
Name:REN, ZEGUANG (MD)
Entity Type:Individual
Prefix:DR
First Name:ZEGUANG
Middle Name:
Last Name:REN
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 1:3000 MEDICAL PARK DR STE 340
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4681
Mailing Address - Country:US
Mailing Address - Phone:813-467-4290
Mailing Address - Fax:813-467-4278
Practice Address - Street 1:3000 MEDICAL PARK DR STE 340
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4681
Practice Address - Country:US
Practice Address - Phone:813-467-4290
Practice Address - Fax:813-467-4278
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME118822207T00000X
CODR.0067702207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012929900Medicaid
FL14WW1OtherBLUE CROSS BLUE SHIELD
FLHX055YMedicare PIN