Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 42660 | CO |
NPI | 1003826843 |
---|---|
Provider Name | Gregory Q Miranda |
First Address | Denver, CO 80204-4507 |
Second Address | Denver, CO 80204-4507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
32721862 | (05) | CO |
I22601 | (02) |