Basic Information
| Provider Information | |||||||||
| NPI: | 1134163728 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JUNOT | ||||||||
| FirstName: | RON | ||||||||
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| Credential: | C.R.N.A | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 130639 | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757130639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035315000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1424 E FRONT ST | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757028501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035954144 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 02/06/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 620477 | TX | N | Nursing Service Providers | Registered Nurse | 367500000X | 620477 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 183604101 | 05 | TX | MEDICAID | 1836041 | 05 | TX | MEDICAID | 86212U | 01 | TX | BCBS OF TEXAS | OTHER |