Individual
MR. ROBERTO N MIRANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1515 HOLCOMBE BLVD, HOUSTON, TX 77030-4009
(713) 792-6161
Mailing address
PO BOX 4439, HOUSTON, TX 77210-4439
(713) 792-2991
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
E2740
TX
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
114313
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
191592801 (MDACC)
—
TX
05
—
209682608
—
MO
01
—
8AL252
BCBS (MDACC)
TX
01
—
P00452927
RR MEDICARE (MDACC)
TX
Enumeration date
02/28/2006
Last updated
06/21/2012
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