Provider Demographics
NPI:1538123062
Name:MUNSON, RONALD G (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:G
Last Name:MUNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4444 CORONA DR STE 130
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4322
Mailing Address - Country:US
Mailing Address - Phone:361-992-4500
Mailing Address - Fax:
Practice Address - Street 1:4444 CORONA DR STE 130
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4322
Practice Address - Country:US
Practice Address - Phone:361-992-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4314207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0025GSOtherBLUECROSS/BLUE SHIELD NUM
TX126184402Medicaid
TX080166383Medicare ID - Type UnspecifiedRAILROAD MEDICARE NUMBER
TX126184402Medicaid
TXB25032Medicare UPIN