Provider Demographics
NPI:1841311222
Name:MIRANDA, JOSE J (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:J
Last Name:MIRANDA
Suffix:
Gender:M
Credentials:MD, MPH
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Other - Credentials:
Mailing Address - Street 1:300 W HOSPITAL RD RM 11C17
Mailing Address - Street 2:EISENHOWER ARMY MEDICAL CENTER
Mailing Address - City:FORT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5650
Mailing Address - Country:US
Mailing Address - Phone:706-787-4657
Mailing Address - Fax:706-787-1745
Practice Address - Street 1:300 W HOSPITAL RD RM 11C17
Practice Address - Street 2:EISENHOWER ARMY MEDICAL CENTER
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5650
Practice Address - Country:US
Practice Address - Phone:706-787-4657
Practice Address - Fax:706-787-1745
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA054420207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAVAD 000Medicare UPIN