Provider Demographics
NPI:1578562476
Name:ROHDE, ALLEN LEE (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:LEE
Last Name:ROHDE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 24TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6313
Mailing Address - Country:US
Mailing Address - Phone:405-329-3929
Mailing Address - Fax:405-366-1669
Practice Address - Street 1:817 24TH AVE NW
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6313
Practice Address - Country:US
Practice Address - Phone:405-329-3929
Practice Address - Fax:405-366-1669
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK155213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0739980001Medicare NSC
OKT40771Medicare UPIN
OK$$$$$$$$$Medicare PIN
OK480002286Medicare PIN
OK0739980002Medicare NSC
OKRRDDBMedicare PIN
OK480022761Medicare PIN