Provider Demographics
NPI:1538139522
Name:DURAL, JUNIUS ETIENNE JR
Entity Type:Individual
Prefix:MR
First Name:JUNIUS
Middle Name:ETIENNE
Last Name:DURAL
Suffix:JR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JUNIUS
Other - Middle Name:ETIENNE
Other - Last Name:DURAL
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:107 CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78374-2935
Mailing Address - Country:US
Mailing Address - Phone:361-643-6623
Mailing Address - Fax:361-643-6964
Practice Address - Street 1:7421 BOURGET DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-5240
Practice Address - Country:US
Practice Address - Phone:361-808-9541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX672807363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily