Basic Information
| Provider Information | |||||||||
| NPI: | 1104825058 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REINSCHMIEDT | ||||||||
| FirstName: | DALE | ||||||||
| MiddleName: | D. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5300 N INDEPENDENCE AVE | ||||||||
| Address2: | 280 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731125556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5805481367 | ||||||||
| FaxNumber: | 5805481583 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 N CHEROKEE ST | ||||||||
| Address2: | |||||||||
| City: | HENNESSEY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 737421106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058537171 | ||||||||
| FaxNumber: | 4058536662 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2005 | ||||||||
| LastUpdateDate: | 01/25/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2297 | OK | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100095020A | 05 | OK | MEDICAID |