Provider Demographics
NPI:1811199029
Name:RENFROW, MARJORIE M (MD)
Entity Type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:M
Last Name:RENFROW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 W 64TH ST STE 125
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66202-4007
Mailing Address - Country:US
Mailing Address - Phone:913-951-3590
Mailing Address - Fax:913-701-3317
Practice Address - Street 1:921 NE 13TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5007
Practice Address - Country:US
Practice Address - Phone:405-456-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301079633207QG0300X
HIMD-13808207QG0300X
ARE-7821207QG0300X
IAMD-43453207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080G376200OtherBLUE CROSS BLUE SHIELD
MI080G376200OtherBLUE CARE NETWORK
MIP00478189OtherRAIL ROAD MEDICARE
MIP00478189OtherRAIL ROAD MEDICARE
MI080G376200OtherBLUE CARE NETWORK