Renaissance Medical Management LLC
Radiology, Diagnostic Radiology in Edmond, OK. Organization (NPI-2).
NPI number1194583963
StatusActive
Last updated in NPPESMar 7, 2024
Details
- NPI
- 1194583963
- Entity type
- Organization (NPI-2)
- Legal business name
- Renaissance Medical Management LLC
- Organization subpart
- No
- Enumeration date
- Mar 7, 2024
- Certification date
- Mar 7, 2024
- Last updated
- Mar 7, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2085R0202X | Radiology, Diagnostic Radiology | – | – | Yes |
Practice location
3509 French Park Dr Ste EEdmond, OK 73034-7291
Phone 405-285-6901 · Fax 405-285-6902
Mailing address
941 W I-35 Frontage Road Ste 116 Pmb 203Edmond, OK 73034
Phone 405-285-6901 · Fax 405-285-6902
Authorized official
Jeffrey Lynn Watts
Owner, Medical Doctor
4052057424
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