MEDICARE: BRIAN E RENZ 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	207W00000X	Ophthalmology Physician	ME36320	FL

General Provider Information

NPI Number	:	1194789743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN E RENZ MD

Provider Business Mailing Address
First Line	:	1247 LAKELAND HILLS BLVD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33805-4673
Country	:	US
Telephone Number	:	863-688-5604
Fax Number	:	863-682-6052

Provider Business Practice Location Address
First Line	:	1247 LAKELAND HILLS BLVD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33805-4673
Country	:	US
Telephone Number	:	863-688-5604
Fax Number	:	863-682-6052

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

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	07/08/2007

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