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General NPI Number Information
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NPI Number | 1629034673
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Entity Type | Individual
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Provider Name | DANIEL ROBERT RENUART M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 10/19/2011
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Provider Practice Location Address
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Address Line | 900 INGRAHAM AVE
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City | HAINES CITY
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State | FL
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Zip | 33844-4336
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Country | US
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Telephone | 863-421-6565
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Fax | 863-421-7474
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Provider Business Mailing Address
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Address Line | 900 INGRAHAM AVE
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City | HAINES CITY
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State | FL
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Zip | 33844-4336
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Country | US
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Telephone | 863-421-6565
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Fax | 863-421-7474
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME 70353
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License Number State | FL
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