Provider Demographics
NPI:1780775726
Name:ALEXIS, RENEE BEVERLY (MD)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:BEVERLY
Last Name:ALEXIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5975 W SUNRISE BLVD
Mailing Address - Street 2:# 105
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33313-6800
Mailing Address - Country:US
Mailing Address - Phone:954-791-4311
Mailing Address - Fax:954-791-2729
Practice Address - Street 1:5975 W SUNRISE BLVD
Practice Address - Street 2:# 105
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33313-6800
Practice Address - Country:US
Practice Address - Phone:954-791-4311
Practice Address - Fax:954-791-2729
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78854207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL51567OtherBC/BS PROVIDER NUMBER
FL51567ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
FL51567OtherBC/BS PROVIDER NUMBER