Provider Demographics
NPI:1114038098
Name:MCCUNE, PHILIP E (DO)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:E
Last Name:MCCUNE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 W LUCAS ST
Mailing Address - Street 2:
Mailing Address - City:MARENGO
Mailing Address - State:IA
Mailing Address - Zip Code:52301-1331
Mailing Address - Country:US
Mailing Address - Phone:319-741-6789
Mailing Address - Fax:319-741-6791
Practice Address - Street 1:255 W LUCAS ST
Practice Address - Street 2:
Practice Address - City:MARENGO
Practice Address - State:IA
Practice Address - Zip Code:52301-1331
Practice Address - Country:US
Practice Address - Phone:319-741-6789
Practice Address - Fax:319-741-6791
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02712207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAE98652Medicare UPIN