Provider Demographics
NPI:1861445991
Name:GRAU, RENEE H (MD)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:H
Last Name:GRAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 268986
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8986
Mailing Address - Country:US
Mailing Address - Phone:405-231-3857
Mailing Address - Fax:405-272-7977
Practice Address - Street 1:9720 BROADWAY EXT
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-6315
Practice Address - Country:US
Practice Address - Phone:405-280-7546
Practice Address - Fax:405-772-8674
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2020-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK22879207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOK403018Medicare PIN
OKOK401909Medicare PIN