Provider Demographics
NPI:1780686717
Name:RENFROE, JAMES BEN (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:BEN
Last Name:RENFROE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32562-0280
Mailing Address - Country:US
Mailing Address - Phone:850-932-5055
Mailing Address - Fax:850-932-1404
Practice Address - Street 1:400 GULF BREEZE PKWY STE 300
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-4458
Practice Address - Country:US
Practice Address - Phone:850-932-5055
Practice Address - Fax:850-932-1401
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME666142084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009946965Medicaid
FL25636OtherBCBS
FL375641600Medicaid
FL25636OtherBCBS
F87806Medicare UPIN