Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 5705 | OK |
Y | 213EG0000X | General Practice | 5705 | OK |
NPI | 1003820903 |
---|---|
Provider Name | Dr. Miriam Nosrati |
First Address | Edmond, OK 73013-6610 |
Second Address | Edmond, OK 73013-6610 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 08/07/2007 |