Provider Demographics
NPI:1972088631
Name:SOUCIER, RENEE LOK-YEE WONG (MD)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:LOK-YEE WONG
Last Name:SOUCIER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1785 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-3221
Mailing Address - Country:US
Mailing Address - Phone:321-269-9612
Mailing Address - Fax:321-269-8433
Practice Address - Street 1:1785 GARDEN ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-3221
Practice Address - Country:US
Practice Address - Phone:321-269-9612
Practice Address - Fax:321-269-8433
Is Sole Proprietor?:No
Enumeration Date:2018-09-28
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME149770207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine