Provider Demographics
NPI:1942264908
Name:MCMINN, ROBERT R JR (CRNA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:R
Last Name:MCMINN
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27319 SAXON MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-3803
Mailing Address - Country:US
Mailing Address - Phone:832-265-3901
Mailing Address - Fax:
Practice Address - Street 1:5300 NORTH ST
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1370
Practice Address - Country:US
Practice Address - Phone:936-687-3242
Practice Address - Fax:936-687-3242
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX511503367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX119947305Medicaid
TX119947305Medicaid
TXR69462Medicare UPIN
TX119947305Medicaid
TX85231HMedicare PIN