Provider Demographics
NPI:1275675662
Name:THOMPSON-MATHEW, MIRIAM ELAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:ELAINE
Last Name:THOMPSON-MATHEW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MIRIAM
Other - Middle Name:ELAINE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:201 S SARA RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-4308
Mailing Address - Country:US
Mailing Address - Phone:405-578-3250
Mailing Address - Fax:405-578-3299
Practice Address - Street 1:201 S SARA RD STE 200
Practice Address - Street 2:
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064-4308
Practice Address - Country:US
Practice Address - Phone:405-578-3250
Practice Address - Fax:405-578-3299
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24609207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200194190AMedicaid
OKOKAAA1036Medicare PIN