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NPI Code Detail

MEDICARE: CONSTANTINO DIAZ MIRANDA MD

MEDICARE: CONSTANTINO DIAZ MIRANDA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine PhysicianTN021298TN

General Provider Information

NPI Number : 1093782963
Entity Type Code : Individual
Provider Name (Legal Business Name) : CONSTANTINO DIAZ MIRANDA MD
Provider Business Mailing Address
First Line : PO BOX 30707
Second Line :
City : KNOXVILLE
State : TN
Zip : 37930-0707
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 435 2ND STREET
Second Line :
City : NEWPORT
State : TN
Zip : 37821-3703
Country : US
Telephone Number : 423-625-2200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2006
Last Update Date : 08/21/2012

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Directions to “ CONSTANTINO DIAZ MIRANDA MD” Practice Location

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