MEDICARE: DR. WILLIAM RENGIFO CAM MD

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	207R00000X	Internal Medicine Physician	ME124828	FL
2	207RG0100X	Gastroenterology Physician	ME124828	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154551653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM RENGIFO CAM MD

Provider Business Mailing Address
First Line	:	501 LIVE OAK ST STE B
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-7300
Country	:	US
Telephone Number	:	386-424-5248
Fax Number	:	386-424-5209

Provider Business Practice Location Address
First Line	:	501 LIVE OAK ST STE B
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-7300
Country	:	US
Telephone Number	:	386-424-5248
Fax Number	:	386-424-5209

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2009
Last Update Date	:	06/03/2020

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