Provider Demographics
NPI:1487679155
Name:MIRANDA, DAVID ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ANTHONY
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 1:5007 GREGORY PL
Mailing Address - Street 2:
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5508
Mailing Address - Country:US
Mailing Address - Phone:601-520-2723
Mailing Address - Fax:
Practice Address - Street 1:1901 SW H K DODGEN LOOP
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-1814
Practice Address - Country:US
Practice Address - Phone:254-771-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3026207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8V2233OtherBCBS
TX8X7458OtherBCBS
TX8V7082OtherBCBS
TX8U4378OtherBCBS
TX8G8156Medicare PIN
TX8F5124Medicare PIN
TX8G7420Medicare PIN
TX8V7082OtherBCBS
TXP00337794Medicare PIN
TXP00415574Medicare PIN
TXP00332858Medicare PIN
TX8U4378OtherBCBS