Provider Demographics
NPI:1689052078
Name:ROHDE, GREG ALLEN (DPM)
Entity type:Individual
Prefix:DR
First Name:GREG
Middle Name:ALLEN
Last Name:ROHDE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 654354
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-4354
Mailing Address - Country:US
Mailing Address - Phone:405-364-7900
Mailing Address - Fax:405-366-6214
Practice Address - Street 1:825 E ROBINSON ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071
Practice Address - Country:US
Practice Address - Phone:405-364-7900
Practice Address - Fax:405-366-6214
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-18
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OK337213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200775470AMedicaid