Provider Demographics
NPI:1568453835
Name:SCHMIDT, DWAYNE A (MD)
Entity Type:Individual
Prefix:DR
First Name:DWAYNE
Middle Name:A
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 QUAIL SPRINGS PARKWAY
Mailing Address - Street 2:STE. 200
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134
Mailing Address - Country:US
Mailing Address - Phone:405-701-9880
Mailing Address - Fax:405-701-9881
Practice Address - Street 1:3200 QUAIL SPRINGS PARKWAY
Practice Address - Street 2:STE. 200
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134
Practice Address - Country:US
Practice Address - Phone:405-701-9880
Practice Address - Fax:405-701-9881
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14792207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK060045009OtherRAILROAD MEDICARE
OK100824430BMedicaid
OK060045009OtherRAILROAD MEDICARE
OKOKA100842Medicare PIN
OK24H616542Medicare PIN
OKOKA100627Medicare PIN