Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081P2900X | Pain Medicine | 31335 | OK |
Y | 2081P2900X | Pain Medicine | R8430 | TX |
NPI | 1083929087 |
---|---|
Provider Name | Dr. Ricardo Aaron Miranda |
First Address | Tampa, FL 33609-1013 |
Second Address | Dallas, TX 75243-3755 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2010 |
Last Update Date | 09/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200599300A | (05) | OK |