Provider Demographics
NPI:1932154267
Name:RINGOLD, MIRANDA JILL (MD)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:JILL
Last Name:RINGOLD
Suffix:
Gender:F
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:P.O. BOX 7627
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36670-0627
Mailing Address - Country:US
Mailing Address - Phone:251-633-7211
Mailing Address - Fax:251-410-6079
Practice Address - Street 1:2350 SCHILLINGER ROAD SOUTH
Practice Address - Street 2:SUITE A
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695
Practice Address - Country:US
Practice Address - Phone:251-633-0123
Practice Address - Fax:251-410-6127
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25427208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01133759Medicaid
AL04-01392OtherUNITED HEALTH CARE
AL009932033Medicaid
AL51529525OtherBLUE CROSS
AL051529525Medicare ID - Type Unspecified
MS01133759Medicaid
I41952Medicare UPIN