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General NPI Number Information
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NPI Number | 1972536597
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Entity Type | Individual
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Provider Name | MARY ANN V MIRANDA MD
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Gender | Female
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 08/15/2024
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Provider Practice Location Address
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Address Line | 2025 MEMORY LN STE 400A
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City | HARKER HEIGHTS
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State | TX
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Zip | 76548-7488
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Country | US
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Telephone | 254-435-4995
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Fax | 254-432-5952
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Provider Business Mailing Address
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Address Line | 303 W MAIN ST
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City | ROUND ROCK
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State | TX
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Zip | 78664-5246
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Country | US
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Telephone | 512-732-2774
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Fax | 512-344-9221
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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 | 25323
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 207RA0201X
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Taxonomy Name | Allergy & Immunology (Internal Medicine) Physician
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License Number | N5247
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License Number State | TX
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