Provider Demographics
NPI:1598922171
Name:REIHELD, MARK EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:EDWARD
Last Name:REIHELD
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 1:736 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-3519
Mailing Address - Country:US
Mailing Address - Phone:580-304-9339
Mailing Address - Fax:405-585-0034
Practice Address - Street 1:1501 E WADE WATTS AVE
Practice Address - Street 2:A
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5651
Practice Address - Country:US
Practice Address - Phone:918-423-0001
Practice Address - Fax:918-423-0009
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23029208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA80325OtherUPIN