Provider Demographics
NPI:1225272651
Name:CHOATE, MIRIAM ELIZABETH (MD/MPH)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:ELIZABETH
Last Name:CHOATE
Suffix:
Gender:F
Credentials:MD/MPH
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 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:541-732-7460
Mailing Address - Fax:
Practice Address - Street 1:940 ROYAL AVE UNIT 350
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6194
Practice Address - Country:US
Practice Address - Phone:541-732-7460
Practice Address - Fax:541-826-5843
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR49311207Q00000X
ORMD157695207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500648246Medicaid