Provider Demographics
NPI:1669565669
Name:MIRANDA, A. RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:A. RICHARD
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ARTURO
Other - Middle Name:RICHARDO
Other - Last Name:MIRANDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 5498
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83303-5498
Mailing Address - Country:US
Mailing Address - Phone:208-736-8001
Mailing Address - Fax:208-329-7159
Practice Address - Street 1:706 N COLLEGE RD
Practice Address - Street 2:SUITE A
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5824
Practice Address - Country:US
Practice Address - Phone:208-736-8006
Practice Address - Fax:208-329-7159
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD151354207RH0003X
IDM-9799207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH55184Medicare UPIN