Provider Demographics
NPI:1790531408
Name:MCCUNE, SPENCER JAMES
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:JAMES
Last Name:MCCUNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10038 MEADOW WAY UNIT D
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-4974
Mailing Address - Country:US
Mailing Address - Phone:805-284-3145
Mailing Address - Fax:
Practice Address - Street 1:10038 MEADOW WAY
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-0482
Practice Address - Country:US
Practice Address - Phone:805-284-3145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-24
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker