Provider Demographics
NPI:1033452412
Name:LAKE CORPUS CHRISTI FAMILY MEDICAL ASSOCIATION
Entity Type:Organization
Organization Name:LAKE CORPUS CHRISTI FAMILY MEDICAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:G
Authorized Official - Last Name:MUNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-992-4500
Mailing Address - Street 1:4444 CORONA DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4324
Mailing Address - Country:US
Mailing Address - Phone:361-992-4500
Mailing Address - Fax:
Practice Address - Street 1:4444 CORONA DR
Practice Address - Street 2:SUITE 130
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4324
Practice Address - Country:US
Practice Address - Phone:361-992-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-03
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty