Provider Demographics
NPI:1922409655
Name:MIRANDA, FRANKLIN (IDMT)
Entity Type:Individual
Prefix:
First Name:FRANKLIN
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 DOOLITTLE DR
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH AFB
Mailing Address - State:SD
Mailing Address - Zip Code:57706-4821
Mailing Address - Country:US
Mailing Address - Phone:605-385-3001
Mailing Address - Fax:
Practice Address - Street 1:55 N WOLFE AVE
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:CA
Practice Address - Zip Code:93524-6201
Practice Address - Country:US
Practice Address - Phone:661-277-1130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians