Provider Demographics
NPI:1699325324
Name:RENAL DIETITIAN SPECIALISTS OF OKLAHOMA
Entity type:Organization
Organization Name:RENAL DIETITIAN SPECIALISTS OF OKLAHOMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:TARR
Authorized Official - Last Name:DESHAZER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD/LD
Authorized Official - Phone:405-906-7133
Mailing Address - Street 1:20 E BLANCH AVE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-3633
Mailing Address - Country:US
Mailing Address - Phone:405-822-6129
Mailing Address - Fax:
Practice Address - Street 1:1 S BROADWAY STE 303
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-3706
Practice Address - Country:US
Practice Address - Phone:405-906-7133
Practice Address - Fax:405-546-2645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-14
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty