Individual
JOSE LUIS MIRA JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1201 HOSPITAL DR, FREDERICKSBURG, VA 22401-8428
(540) 368-3700
Mailing address
8328 E HARRISON CT, FREDERICKSBURG, VA 22407-1906
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101266677
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
SC
Other
Enumeration date
06/27/2016
Last updated
01/10/2022
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