Individual
FEDERICO CARLOS DE MIRANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7303 ROGERS AVE, SUITE 200, FORT SMITH, AR 72903-4165
(479) 314-4810
(479) 314-2075
Mailing address
7303 ROGERS AVE, SUITE 200, FORT SMITH, AR 72903-4165
(479) 314-4810
(479) 314-2075
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
C-5393
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105837001
—
AR
05
—
150597002
—
AR
01
—
5-1332
BCBS IND. #
AR
01
—
F31893
BCBS CORP #
AR
Enumeration date
04/06/2006
Last updated
02/13/2014
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