Provider Demographics
NPI:1851752158
Name:HERNAN E. MIRANDA MD PA
Entity Type:Organization
Organization Name:HERNAN E. MIRANDA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HERNAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-350-7355
Mailing Address - Street 1:1301 S COULTER ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1763
Mailing Address - Country:US
Mailing Address - Phone:806-350-7355
Mailing Address - Fax:806-350-7362
Practice Address - Street 1:1301 S COULTER ST
Practice Address - Street 2:SUITE 104
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1763
Practice Address - Country:US
Practice Address - Phone:806-350-7355
Practice Address - Fax:806-350-7362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0984207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty