Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | H7792 | TX |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | H7792 | TX |
NPI | 1093785230 |
---|---|
Provider Name | Dr. Egbert Miranda |
First Address | Corpus Christi, TX 78413-3842 |
Second Address | Corpus Christi, TX 78413-3842 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2006 |
Last Update Date | 11/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1093785230 | NPI (01) | TX |
153378801 | TPI # (01) | TX |
E28860 | (02) | TX |