Provider Demographics
NPI:1558385708
Name:RHOADES, REGINA MARIE (DPM)
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:MARIE
Last Name:RHOADES
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:REGINA
Other - Middle Name:MARIE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:1125 N PORTER AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-6443
Mailing Address - Country:US
Mailing Address - Phone:405-307-8503
Mailing Address - Fax:405-307-0606
Practice Address - Street 1:1300 MCGEE DR
Practice Address - Street 2:SUITE 106
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-5858
Practice Address - Country:US
Practice Address - Phone:405-307-8503
Practice Address - Fax:405-307-0606
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK196213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100780470AMedicaid
480027773OtherRR MCR
OK100780470AMedicaid
5590150001Medicare NSC