Provider Demographics
NPI:1790819241
Name:MCCUNE, BRIAN C (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:C
Last Name:MCCUNE
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 1:41 E 1140 N.
Mailing Address - Street 2:STE. B
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-5459
Mailing Address - Country:US
Mailing Address - Phone:801-407-6500
Mailing Address - Fax:801-407-6505
Practice Address - Street 1:41 E 1140 N.
Practice Address - Street 2:STE. B
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045-5459
Practice Address - Country:US
Practice Address - Phone:801-407-6500
Practice Address - Fax:801-407-6505
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6521379-1205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics