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General NPI Number Information
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NPI Number | 1437340601
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Entity Type | Organization
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Legal Business Name | ROBERT R MCMINN
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 08/05/2007
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Provider Practice Location Address
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Address Line | 5300 NORTH ST
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City | NACOGDOCHES
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State | TX
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Zip | 75965-1370
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Country | US
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Telephone | 936-687-3242
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Fax | 936-687-3242
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Provider Business Mailing Address
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Address Line | PO BOX 1043
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City | CROCKETT
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State | TX
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Zip | 75835-1043
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Country | US
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Telephone | 936-687-3242
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Fax | 936-687-3242
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Authorized Official
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Title or Position | TAXONOMY X
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Name | MR. ROBERT R MCMINN II
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Credential | CRNA
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Telephone | 936-546-3733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 511503
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License Number State | TX
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