Provider Demographics
NPI:1104825058
Name:REINSCHMIEDT, DALE D (DO)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:D
Last Name:REINSCHMIEDT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:580-548-1367
Mailing Address - Fax:580-548-1583
Practice Address - Street 1:300 N CHEROKEE ST
Practice Address - Street 2:
Practice Address - City:HENNESSEY
Practice Address - State:OK
Practice Address - Zip Code:73742-1106
Practice Address - Country:US
Practice Address - Phone:405-853-7171
Practice Address - Fax:405-853-6662
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2297207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100095020AMedicaid
OKOK401988Medicare PIN
E11024Medicare UPIN
OK100095020AMedicaid