Provider Demographics
NPI:1881804052
Name:RENFROE & ZIEMAN, P.A.
Entity type:Organization
Organization Name:RENFROE & ZIEMAN, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-932-2266
Mailing Address - Street 1:13 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-4370
Mailing Address - Country:US
Mailing Address - Phone:850-932-2266
Mailing Address - Fax:850-934-1242
Practice Address - Street 1:13 CENTER ST
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-4370
Practice Address - Country:US
Practice Address - Phone:850-932-2266
Practice Address - Fax:850-934-1242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN47691223G0001X
FLDN60121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID NUMBER