Provider Demographics
NPI:1114120631
Name:IRA, JOANNA K (MD)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:K
Last Name:IRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JOANNA
Other - Middle Name:K
Other - Last Name:SMIECHOWSKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3855 TARTAN LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-2411
Mailing Address - Country:US
Mailing Address - Phone:281-413-8078
Mailing Address - Fax:
Practice Address - Street 1:1905 HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4123
Practice Address - Country:US
Practice Address - Phone:713-677-7262
Practice Address - Fax:713-677-7184
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6480207R00000X, 207RG0300X, 207RH0002X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB158821OtherMEDICARE INDIVIDUAL PTAN
TX8M9182OtherBLUE CROSS BLU SHIELD
TXTXB158820OtherMEDICARE GROUP PTAN