Provider Demographics
NPI:1215985569
Name:REINECKE, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:REINECKE
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 1:1715 N LYNN RIGGS BLVD
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-3056
Mailing Address - Country:US
Mailing Address - Phone:918-342-4222
Mailing Address - Fax:918-342-0066
Practice Address - Street 1:1715 N LYNN RIGGS BLVD
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-3056
Practice Address - Country:US
Practice Address - Phone:918-342-4222
Practice Address - Fax:918-342-0066
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15906174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK42378191TMedicare PIN
4182310001Medicare NSC
4182310002Medicare NSC
OKB42676Medicare UPIN