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General NPI Number Information
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NPI Number | 1881082238
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Entity Type | Organization
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Legal Business Name | RENAISSANCE HEALTH AND WELLNESS OF TEXAS, P.A.
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Dates
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Enumeration Date | 01/07/2015
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Last Update Date | 01/07/2015
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Provider Practice Location Address
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Address Line | 17721 DALLAS PKWY SUITE 116
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City | DALLAS
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State | TX
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Zip | 75287-7343
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Country | US
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Telephone | 214-378-4700
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Fax |
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Provider Business Mailing Address
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Address Line | 17721 DALLAS PKWY SUITE 116
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City | DALLAS
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State | TX
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Zip | 75287-7343
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Country | US
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Telephone | 214-378-4700
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | CHESTER L CARLSON
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Credential | D.O.
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Telephone | 479-434-4948
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | Q2522
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License Number State | TX
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