Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CH5606 | FL |
NPI | 1164492815 |
---|---|
Provider Name | Dr. John Mark Renfroe |
First Address | Pensacola, FL 32514-5723 |
Second Address | Pensacola, FL 32514-5723 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 20/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T85543 | (02) | FL |