Provider Demographics
NPI:1720268550
Name:REGINA M. SMITH, DPM INC.
Entity Type:Organization
Organization Name:REGINA M. SMITH, DPM INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RHOADES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:405-307-8503
Mailing Address - Street 1:1300 MCGEE DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-5774
Mailing Address - Country:US
Mailing Address - Phone:405-307-8503
Mailing Address - Fax:
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:73072-5774
Practice Address - Country:US
Practice Address - Phone:405-307-8503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK196213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CH2570OtherRR MCR
OK100780470AMedicaid
CH2570OtherRR MCR
OK100780470AMedicaid
U68002Medicare UPIN