Provider Demographics
NPI:1760529960
Name:SMITH, MIRANDA ELISABETH (MD)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:ELISABETH
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:ELISABETH
Other - Last Name:HOEHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3915 E 51ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-3605
Mailing Address - Country:US
Mailing Address - Phone:918-749-5714
Mailing Address - Fax:918-749-5826
Practice Address - Street 1:3915 E 51ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-3605
Practice Address - Country:US
Practice Address - Phone:918-749-5714
Practice Address - Fax:918-749-5826
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25108207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology