Individual
DR. MIRAN JOELLE SONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2920 N 4TH ST, FLAGSTAFF, AZ 86004-1816
(928) 522-9400
(928) 774-4808
Mailing address
PO BOX 3630, FLAGSTAFF, AZ 86003-3630
(928) 522-9400
(928) 774-4808
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
161302
MA
208000000X
Pediatrics Physician
Primary
49275
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
060012
—
AZ
Enumeration date
02/07/2006
Last updated
03/22/2021
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