Provider Demographics
NPI:1558441402
Name:MCCUNE, DOUGLAS LAWRENCE (DPM)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:LAWRENCE
Last Name:MCCUNE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3433
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-2433
Mailing Address - Country:US
Mailing Address - Phone:562-795-6210
Mailing Address - Fax:562-795-6272
Practice Address - Street 1:1661 GOLDEN RAIN RD
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-4907
Practice Address - Country:US
Practice Address - Phone:562-795-6210
Practice Address - Fax:562-795-6272
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3596213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine