Healthcare Provider Details

I. General information

NPI: 1497919294
Provider Name (Legal Business Name): RENAISSANCE PHYSICIAN ORGANIZATION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2008
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 NORTH LOOP W SUITE 1300
HOUSTON TX
77092-8841
US

IV. Provider business mailing address

2900 NORTH LOOP W SUITE 1300
HOUSTON TX
77092-8841
US

V. Phone/Fax

Practice location:
  • Phone: 832-553-3300
  • Fax:
Mailing address:
  • Phone: 832-553-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: ALLEN PEREZ
Title or Position: PRESIDENT
Credential:
Phone: 832-553-3300