Provider Demographics
NPI:1780634675
Name:PEROCIER, RENEE MARGARITA (MD)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:MARGARITA
Last Name:PEROCIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 PLEASANT HILL RD STE 112
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759-3400
Mailing Address - Country:US
Mailing Address - Phone:786-374-1637
Mailing Address - Fax:
Practice Address - Street 1:4545 PLEASANT HILL RD STE 112
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-3400
Practice Address - Country:US
Practice Address - Phone:786-374-1637
Practice Address - Fax:407-749-6135
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301083263207Q00000X
PR2839207V00000X
FLACN566207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015078300Medicaid
AZ8HBV90Medicare ID - Type Unspecified
AZE31425Medicare UPIN