Provider Demographics
NPI:1093810418
Name:REGINALD, GAYE (LD)
Entity Type:Individual
Prefix:
First Name:GAYE
Middle Name:
Last Name:REGINALD
Suffix:
Gender:F
Credentials:LD
Other - Prefix:
Other - First Name:GAYE
Other - Middle Name:
Other - Last Name:WOODS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LD
Mailing Address - Street 1:4401 W MEMORIAL RD
Mailing Address - Street 2:SUITE #141; ATTN: TERRI
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1785
Mailing Address - Country:US
Mailing Address - Phone:405-936-5800
Mailing Address - Fax:405-936-5211
Practice Address - Street 1:4300 W MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8304
Practice Address - Country:US
Practice Address - Phone:405-752-3758
Practice Address - Fax:405-936-5288
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK577133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK577OtherLD LICENSE
OK244403605Medicare PIN