Healthcare Provider Details

I. General information

NPI: 1104825058
Provider Name (Legal Business Name): DALE D. REINSCHMIEDT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N CHEROKEE ST
HENNESSEY OK
73742-1106
US

IV. Provider business mailing address

5300 N INDEPENDENCE AVE 280
OKLAHOMA CITY OK
73112-5556
US

V. Phone/Fax

Practice location:
  • Phone: 405-853-7171
  • Fax: 405-853-6662
Mailing address:
  • Phone: 580-548-1367
  • Fax: 580-548-1583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2297
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: