| Organization Name: | MIRANDA MEDICAL, PLLC |
| NPI Number: | 1053765545 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | A RICHARD MIRANDA (CEO) |
| Mailing Address: | 706 N College Rd Suite A Twin Falls |
| State: | ID US |
| Postal Code: | 833015824 |
| Phone Number: | 2087368006 |
| Fax Number: | 2083297159 |
| NPI Enumeration Date: | 04/20/2016 |
| NPI Last Update Date: | 04/20/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207RH0003X |
| License Number: | MD151354 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OR |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Internal Medicine |
| Taxonomy Specialization: | Hematology & Oncology |
| Taxonomy Definition: | An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. |