Provider Demographics
NPI:1790762888
Name:MIRAMONTES, DAVID ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALAN
Last Name:MIRAMONTES
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 1:7703 FLOYD CURL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3901
Mailing Address - Country:US
Mailing Address - Phone:210-358-2078
Mailing Address - Fax:
Practice Address - Street 1:4502 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4402
Practice Address - Country:US
Practice Address - Phone:210-358-2078
Practice Address - Fax:210-358-1972
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073075207P00000X, 207PE0004X
TXQ2348207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX344514001Medicaid
OH2058535Medicaid
OH000000377189OtherBCBS ERIE
OH000000537084OtherBC/BS LUCAS COUNTY
MI010A311840OtherANTHEM BLUE CROSS/GROUP
OHP00274263Medicare PIN
MIP00642786Medicare PIN
OH000000537084OtherBC/BS LUCAS COUNTY
OHG73088Medicare UPIN
OHMI0871798Medicare PIN
OH0871794Medicare PIN
MI010A311840OtherANTHEM BLUE CROSS/GROUP
TX397678YK00Medicare PIN
OH0871795Medicare PIN