Individual
DR. WIDALYS SANTIAGO MIRANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
140 W GOVERNMENT ST, PENSACOLA, FL 32502-5703
(918) 616-3366
Mailing address
PO BOX 4274, MILTON, FL 32572-4274
(918) 616-3366
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
17440
PR
208D00000X
General Practice Physician
Primary
ACN885
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ACN885
ACN MEDICAL LICENSE
FL
Enumeration date
01/14/2009
Last updated
03/07/2023
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