Provider Demographics
NPI:1205989613
Name:MIRANDA, JORGE ENRIQUE (MD, FACOG)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:ENRIQUE
Last Name:MIRANDA
Suffix:
Gender:M
Credentials:MD, FACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5208 N 10TH ST # 4016
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2701
Mailing Address - Country:US
Mailing Address - Phone:956-581-2168
Mailing Address - Fax:956-581-2169
Practice Address - Street 1:3001 N 23RD ST STE 1
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-6179
Practice Address - Country:US
Practice Address - Phone:956-581-2168
Practice Address - Fax:956-581-2169
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2458207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098923803Medicaid
TX8417M1Medicare ID - Type Unspecified
TXF33456Medicare UPIN