Provider Demographics
NPI:1285673012
Name:MIRANDA, EDUARDO (MD)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 451369
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-0033
Mailing Address - Country:US
Mailing Address - Phone:956-724-8543
Mailing Address - Fax:956-724-8352
Practice Address - Street 1:2344 LAGUNA DEL MAR CT
Practice Address - Street 2:SUITE 104
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-3470
Practice Address - Country:US
Practice Address - Phone:956-724-8543
Practice Address - Fax:956-724-8352
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8347174400000X, 207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No174400000XOther Service ProvidersSpecialist
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0899965 01Medicaid
TXE21360Medicare UPIN
TX0899965 01Medicaid
TX00392JMedicare ID - Type Unspecified
TX00392JMedicare PIN