| NPI | 1093974511 |
|---|---|
| NPI Type | NPI-1 Individual |
| Status | Active |
| Enumeration Date | 2008-06-09 |
| Last Updated | 2021-01-26 |
| Mailing Address | 110 S Woodland St Winter Garden, FL 34787-3546 United States Phone: (407) 905-8827 | Fax: (407) 905-8998 📍 View Map |
| Primary Practice Address | 1296 W Broad St Groveland, FL 34736-2012 United States Phone: (407) 905-8827 | Fax: (352) 429-5606 📍 View Map |
| Issuer | State | Number | Other Issuer |
|---|---|---|---|
| MEDICAID | FL | 108872000 | — |
| Primary | Taxonomy Code & Description | State | License Number |
|---|---|---|---|
| Yes | 207Q00000X – Family Medicine | NY | 264985-1 |
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About NPI 1093974511
Reo Malachi Peniston M.D. is a healthcare provider registered in the CMS NPPES NPI Registry with NPI number 1093974511. The primary specialty listed is Family Medicine. The provider is located in Groveland, FL. This NPI is classified as a Type 1 (Individual) NPI and is currently active. The NPI was first enumerated (assigned) on 2008-06-09. All data is sourced directly from the official CMS NPPES public API and is updated daily.
Frequently Asked Questions
What is NPI 1093974511?
NPI 1093974511 belongs to Reo Malachi Peniston M.D., a Family Medicine in Groveland, FL. It is a Type 1 Individual NPI registered in the CMS NPPES NPI Registry.
Is NPI 1093974511 active?
The current status of NPI 1093974511 in the NPPES registry is Active. The record was last updated on 2021-01-26.
What specialty is NPI 1093974511?
NPI 1093974511 is classified under the taxonomy Family Medicine. Taxonomy codes in NPPES are maintained by the National Uniform Claim Committee (NUCC) and identify the provider's type, classification, and specialization.
How do I verify NPI 1093974511?
You can verify NPI 1093974511 at the official CMS NPPES website at npiregistry.cms.hhs.gov or using our free NPI Lookup tool above. All data shown on this page is sourced directly from the official NPPES public API and is updated daily by CMS.
What address is on file for NPI 1093974511?
The primary practice address on file for NPI 1093974511 is 1296 W Broad St, Groveland, FL 34736-2012. This address is registered in the NPPES system and providers are required to update it within 30 days of any change.
When was NPI 1093974511 issued?
NPI 1093974511 was first issued (enumerated) on 2008-06-09. The NPPES record was last updated on 2021-01-26.
Practice Location Map
Reo Malachi Peniston is located at 1296 W Broad St, Groveland, FL. Use the map below to find directions or verify the practice location.
Related Healthcare Providers
The following providers share the same practice location, specialty, or state as Reo Malachi Peniston. All records sourced from the CMS NPPES registry.
License Information
The following state license numbers are on file in the NPPES registry for NPI 1093974511. For license status verification, contact the relevant state licensing board directly.
| Specialty / Taxonomy | License Number | State |
|---|---|---|
| Family Medicine | 264985-1 | NY |