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General NPI Number Information
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NPI Number | 1245499078
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Entity Type | Individual
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Provider Name | ANTHONY LOREN MIRANDA MD
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Gender | Male
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Dates
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Enumeration Date | 06/06/2008
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 239 STONY BROOK CIR
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City | JACKSON
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State | GA
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Zip | 30233-4571
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Country | US
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Telephone | 209-306-4796
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Fax | 478-247-8448
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Provider Business Mailing Address
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Address Line | 2660 W COVELL BLVD
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City | DAVIS
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State | CA
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Zip | 95616-5645
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Country | US
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Telephone | 530-747-3000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 070199
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | TPME1727
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | C165064
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License Number State | CA
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