Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 199959 | LA |
NPI | 1104845080 |
---|---|
Provider Name | Diego A Miranda |
First Address | Bossier City, LA 71111 |
Second Address | Bossier City, LA 71111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 16/01/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1478997 | (05) | LA |
I26589 | (02) | LA |