Provider Demographics
NPI:1487691655
Name:MIRANDA, EDGAR G (MD)
Entity type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:G
Last Name:MIRANDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 102222
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:239-278-3350
Practice Address - Street 1:3280 N MCMULLEN BOOTH RD STE 200
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2046
Practice Address - Country:US
Practice Address - Phone:727-216-1141
Practice Address - Fax:727-796-1590
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME73863207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266946300Medicaid
FLP00663688OtherRR MEDICARE
FL266946300Medicaid
FL78756YMedicare PIN