Provider Demographics
NPI:1285725515
Name:MIRANDA, ALEXANDER ALBERT (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:ALBERT
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 1:3385 BURNS RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4328
Mailing Address - Country:US
Mailing Address - Phone:561-429-2510
Mailing Address - Fax:561-429-2514
Practice Address - Street 1:3385 BURNS RD
Practice Address - Street 2:SUITE 203
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4328
Practice Address - Country:US
Practice Address - Phone:561-429-2510
Practice Address - Fax:561-429-2514
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12677207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0475599-00Medicaid
D85861Medicare UPIN
50484Medicare ID - Type Unspecified