Provider Demographics
NPI:1255343323
Name:MIRANDA, JOSE RAMON (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:RAMON
Last Name:MIRANDA
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:PO BOX 51401
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-1401
Mailing Address - Country:US
Mailing Address - Phone:787-269-3715
Mailing Address - Fax:
Practice Address - Street 1:100 PASEO SAN PABLO
Practice Address - Street 2:SUITE 402 DR. ARTURO CADILLA BLDG.
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7019
Practice Address - Country:US
Practice Address - Phone:787-269-3715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8690207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR29865Medicare ID - Type Unspecified
PRD34220Medicare UPIN