MEDICARE: RENEE ROY, MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992735617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENEE ROY, MD PC

Provider Business Mailing Address
First Line	:	PO BOX 268970
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73126-8970
Country	:	US
Telephone Number	:	405-231-3857
Fax Number	:	405-272-4948

Provider Business Practice Location Address
First Line	:	10002 SE 15TH ST
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-5626
Country	:	US
Telephone Number	:	405-732-2299
Fax Number	:	405-732-0899

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RENEE ROY
Credential	:	MD
Telephone Number	:	405-732-2299

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	02/11/2010

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