Provider Demographics
NPI:1588923130
Name:SHIRES, ERNESTINE CAROL (MD)
Entity type:Individual
Prefix:DR
First Name:ERNESTINE
Middle Name:CAROL
Last Name:SHIRES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ERNESTINE
Other - Middle Name:CAROL
Other - Last Name:NAIFEH-SHIRES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:601 S HARBOUR ISLAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5925
Mailing Address - Country:US
Mailing Address - Phone:800-480-5243
Mailing Address - Fax:800-928-7449
Practice Address - Street 1:3325 S BOULEVARD STE 113
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-4812
Practice Address - Country:US
Practice Address - Phone:405-330-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16913208600000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100103000AMedicaid