Provider Demographics
NPI:1588658884
Name:MCCAW, GUY M (MD)
Entity Type:Individual
Prefix:DR
First Name:GUY
Middle Name:M
Last Name:MCCAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112-1898
Mailing Address - Country:US
Mailing Address - Phone:641-236-2900
Mailing Address - Fax:641-236-2910
Practice Address - Street 1:210 4TH AVE
Practice Address - Street 2:
Practice Address - City:GRINNELL
Practice Address - State:IA
Practice Address - Zip Code:50112-1898
Practice Address - Country:US
Practice Address - Phone:641-236-2900
Practice Address - Fax:641-236-2910
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-01
Last Update Date:2008-10-16
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
IA25513207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA010064913OtherRR MEDICARE #
IA17744OtherBCBS PROVIDER #
IA4032029Medicaid
IA010064913OtherRR MEDICARE #
IA17744OtherBCBS PROVIDER #