Provider Demographics
NPI:1215958400
Name:RENELIEN, JEAN LAVENTURE (MD)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:LAVENTURE
Last Name:RENELIEN
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 1:1325 S CONGRESS AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-5802
Mailing Address - Country:US
Mailing Address - Phone:561-733-2929
Mailing Address - Fax:561-736-8467
Practice Address - Street 1:1325 S CONGRESS AVE STE 101
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-5802
Practice Address - Country:US
Practice Address - Phone:561-733-2929
Practice Address - Fax:561-736-8467
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86189207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000114686OtherHUMANA
FL286602OtherAMERIGROUP
FL2659555700Medicaid
FL7124458OtherAETNA
FL7104OtherCARE ACCESS
FL299588OtherAVMED
FL24112208OtherGOLDEN RULE
FL286602OtherAMERIGROUP
FL24112208OtherGOLDEN RULE
FL1215958400Medicare NSC