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NPI Code Detail

MEDICARE: DR. THOMAS BENJAMIN DE MIRANDA M.D.

MEDICARE: DR. THOMAS BENJAMIN DE 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
1208VP0014XInterventional Pain Medicine PhysicianE-6411AR
2207Q00000XFamily Medicine PhysicianE-6411AR
3207Q00000XFamily Medicine Physician27166OK

General Provider Information

NPI Number : 1689866725
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THOMAS BENJAMIN DE MIRANDA M.D.
Provider Business Mailing Address
First Line : 2707 MARKET TRCE
Second Line :
City : FORT SMITH
State : AR
Zip : 72908-8694
Country : US
Telephone Number : 479-434-3600
Fax Number : 833-992-0797
Provider Business Practice Location Address
First Line : 2707 MARKET TRCE
Second Line :
City : FORT SMITH
State : AR
Zip : 72908-8694
Country : US
Telephone Number : 479-434-3600
Fax Number : 833-992-0797
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2007
Last Update Date : 03/20/2025

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