Provider Demographics
NPI:1619310422
Name:SUPER, MARIA ELIZABETH (DO)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:ELIZABETH
Last Name:SUPER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2000 S WHEELING AVE STE 701
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5647
Mailing Address - Country:US
Mailing Address - Phone:918-403-7801
Mailing Address - Fax:918-403-6437
Practice Address - Street 1:2000 S WHEELING AVE STE 701
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5647
Practice Address - Country:US
Practice Address - Phone:918-403-7801
Practice Address - Fax:918-403-6437
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5635207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine