Provider Demographics
NPI:1093785230
Name:MIRANDA, EGBERT (MD)
Entity type:Individual
Prefix:DR
First Name:EGBERT
Middle Name:
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 1:5934 S STAPLES ST STE 205
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-3842
Mailing Address - Country:US
Mailing Address - Phone:361-991-5520
Mailing Address - Fax:361-991-5521
Practice Address - Street 1:5934 S STAPLES ST STE 205
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-3842
Practice Address - Country:US
Practice Address - Phone:361-991-5520
Practice Address - Fax:361-991-5521
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7792207RE0101X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1093785230OtherNPI
TX153378801OtherTPI #