1558385708 NPI number — DR. REGINA MARIE RHOADES D.P.M.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558385708 NPI number — DR. REGINA MARIE RHOADES D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RHOADES
Provider First Name:
REGINA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMITH
Provider Other First Name:
REGINA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.P.M.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1558385708
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1125 N PORTER AVE
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
NORMAN
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73071-6443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-307-8503
Provider Business Mailing Address Fax Number:
405-307-0606

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 MCGEE DR
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
NORMAN
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73072-5858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-307-8503
Provider Business Practice Location Address Fax Number:
405-307-0606
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  196 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100780470A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 480027773 . This is a "RR MCR" identifier . This identifiers is of the category "OTHER".




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