Individual
CONSTANTINO DIAZ MIRANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
435 2ND STREET, NEWPORT, TN 37821-3703
(423) 625-2200
Mailing address
PO BOX 30707, KNOXVILLE, TN 37930-0707
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
TN021298
TN
Other
Enumeration date
03/01/2006
Last updated
08/21/2012
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