Provider Demographics
NPI:1174534796
Name:MIRANDA, RICHARD H (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:H
Last Name:MIRANDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1719 E 19TH AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1235
Mailing Address - Country:US
Mailing Address - Phone:303-869-2160
Mailing Address - Fax:303-869-2544
Practice Address - Street 1:1960 OGDEN ST
Practice Address - Street 2:SUITE 400
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-3666
Practice Address - Country:US
Practice Address - Phone:303-318-1540
Practice Address - Fax:303-318-2479
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2015-01-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO40540207R00000X, 208000000X, 207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO29352266Medicaid
CO49280732Medicaid
COCOB4978Medicare PIN