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Organization

RENAISSANCE MEDICAL OF OKLAHOMA, P.C.

Active
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Organization

RENAISSANCE MEDICAL OF OKLAHOMA, P.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CHESTER L CARLSON D.O. (PRESIDENT)
(479) 434-4948
Entity
Organization

Contact information

Practice address
8014 SOUTH 101 EAST AVE, SUITE 200, TULSA, OK 74133
(479) 434-4948
Mailing address
PO BOX 35746, TULSA, OK 74153-0746
(479) 434-4948

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—

Other

Enumeration date
08/27/2014
Last updated
08/27/2014
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