# EGBERT MIRANDA MDPA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366537201
- **Authorized official:** EGBERT MIRANDA MD (OWNER)
- **Authorized official phone:** (361) 991-5520

## Contact information

- **Practice address:** 5866 S STAPLES ST, STE. 403, CORPUS CHRISTI, TX 78413-3700
- **Practice address phone:** (361) 991-5520
- **Practice address fax:** (361) 991-5521
- **Mailing address:** 5866 S STAPLES ST, STE. 403, CORPUS CHRISTI, TX 78413-3700
- **Mailing address phone:** (361) 991-5520
- **Mailing address fax:** (361) 991-5521

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/04/2006
- **Last updated:** 10/03/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 00F33D | BLUECROSS BLUESHIELD | TX |
| 05 | — | 153788-01 | — | TX |