MEDICARE: DR. ROBERTO MIRANDA M.D.

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
1	207Q00000X	Family Medicine Physician	E2740	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00318Q	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891798633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERTO MIRANDA M.D.

Provider Business Mailing Address
First Line	:	1508 DESSAU RIDGE LN APT 602
Second Line	:	STE B
City	:	AUSTIN
State	:	TX
Zip	:	78754-2121
Country	:	US
Telephone Number	:	512-477-9202
Fax Number	:	512-472-9473

Provider Business Practice Location Address
First Line	:	1508 DESSAU RIDGE LN APT 602
Second Line	:	STE B
City	:	AUSTIN
State	:	TX
Zip	:	78754-2121
Country	:	US
Telephone Number	:	512-477-9202
Fax Number	:	512-472-9473

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	01/11/2011

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