Individual
JOHN RYAN MCCUBBIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
140 TIMBER FALLS DR, LONGVIEW, TX 75605-8277
(903) 297-8640
Mailing address
140 TIMBER FALLS DR, LONGVIEW, TX 75605-8277
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
658202
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164937801
—
TX
Enumeration date
07/05/2006
Last updated
01/28/2009
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