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NPI Code Detail

MEDICARE: MARY V MIRTO D.O.

MEDICARE: MARY V MIRTO D.O.
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
1207V00000XObstetrics & Gynecology PhysicianL1674TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1861403917
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY V MIRTO D.O.
Provider Business Mailing Address
First Line : PO BOX 844658
Second Line :
City : DALLAS
State : TX
Zip : 75284-4658
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2608 BROCKTON DR
Second Line :
City : AUSTIN
State : TX
Zip : 78758-4414
Country : US
Telephone Number : 512-654-4050
Fax Number : 512-654-4051
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2006
Last Update Date : 01/25/2022

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Directions to “ MARY V MIRTO D.O.” Practice Location

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