Provider Demographics
NPI:1265492144
Name:RENOUARD, ROBERT S (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:RENOUARD
Suffix:
Gender:M
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:PO BOX 2263
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73101-2263
Mailing Address - Country:US
Mailing Address - Phone:405-842-4850
Mailing Address - Fax:405-842-9612
Practice Address - Street 1:5300 N GRAND BLVD
Practice Address - Street 2:STE 200
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-5517
Practice Address - Country:US
Practice Address - Phone:405-946-2500
Practice Address - Fax:405-946-2506
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19654208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100205940AMedicaid
OK100205940AMedicaid
5390430018Medicare NSC
OK100205940AMedicaid
OKP00384215Medicare PIN
246702904Medicare PIN