Individual
MR. MASON SCOTT MIRANDA I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1010 N KANSAS ST, WICHITA, KS 67214-3124
(316) 293-2635
Mailing address
1010 N KANSAS ST, WICHITA, KS 67214-3124
(316) 293-2635
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
3-116928
KS
Other
Enumeration date
12/11/2025
Last updated
12/11/2025
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