# RENAISSANCE MEDICAL OF OKLAHOMA, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831599737
- **Authorized official:** CHESTER L CARLSON D.O. (PRESIDENT)
- **Authorized official phone:** (479) 434-4948

## Contact information

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

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/27/2014
- **Last updated:** 08/27/2014