| Egbert Miranda Mdpa | |
|
5866 S Staples St Ste. 403 Corpus Christi TX 78413-3700 | |
| (361) 991-5520 | |
| (361) 991-5521 |
| Full Name | Egbert Miranda Mdpa |
|---|---|
| Speciality | Internal Medicine |
| Location | 5866 S Staples St, Corpus Christi, Texas |
| Authorized Official Name and Position | Egbert Miranda (OWNER) |
| Authorized Official Contact | 3619915520 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Egbert Miranda Mdpa 5866 S Staples St Ste. 403 Corpus Christi TX 78413-3700 Ph: (361) 991-5520 | Egbert Miranda Mdpa 5866 S Staples St Ste. 403 Corpus Christi TX 78413-3700 Ph: (361) 991-5520 |
| NPI Number | 1366537201 |
|---|---|
| Provider Enumeration Date | 10/04/2006 |
| Last Update Date | 10/03/2007 |
| Medicare PECOS PAC ID | 6305894882 |
|---|---|
| Medicare Enrollment ID | O20050111000833 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366537201 | NPI | - | NPPES |
| 00F33D | Other | TX | BLUECROSS BLUESHIELD |
| 153788-01 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | (* (Not Available)) | Primary |
| Provider Name | Egbert Miranda |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1093785230 PECOS PAC ID: 8224027495 Enrollment ID: I20040511001647 |
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