Provider Demographics
NPI:1639283534
Name:MIRANDA-SOUSA, ALEJANDRO J (MD)
Entity Type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:J
Last Name:MIRANDA-SOUSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:392-599-2612
Practice Address - Street 1:4571 COLONIAL BLVD STE 110
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-1156
Practice Address - Country:US
Practice Address - Phone:239-226-2727
Practice Address - Fax:239-939-9876
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA227880208800000X
FLME111307208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01052889OtherRAILROAD MEDICARE
FL355413OtherAVMED
FLP1000190OtherFREEDOM HEALTH
FL362828OtherUNIVERSAL HEALTHCARE
FL14JS5OtherBLUE CROSS BLUE SHIELD OF FLORIDA
FL6442922OtherCIGNA
FL14JS5OtherBLUE CROSS BLUE SHIELD
FL9238059OtherAETNA
FLP941227OtherFREEDOM HEALTH - OPTIMUM
FLP01052889OtherRAILROAD MEDICARE
FLP1000190OtherFREEDOM HEALTH