MEDICARE: P. RENE NAVARRO, MD, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	ME28167	FL

General Provider Information

NPI Number	:	1063609634
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	P. RENE NAVARRO, MD, PA

Provider Business Mailing Address
First Line	:	1137 DRUID CIR
Second Line	:
City	:	LAKE WALES
State	:	FL
Zip	:	33853-4339
Country	:	US
Telephone Number	:	863-676-0702
Fax Number	:	863-676-2305

Provider Business Practice Location Address
First Line	:	1137 DRUID CIR
Second Line	:
City	:	LAKE WALES
State	:	FL
Zip	:	33853-4339
Country	:	US
Telephone Number	:	863-676-0702
Fax Number	:	863-676-2305

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RENE NAVARRO
Credential	:	MD
Telephone Number	:	863-676-0702

Provider Enumeration Date	:	09/27/2007
Last Update Date	:	11/20/2009

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