Provider Demographics
NPI:1538413281
Name:MCCUNE, CRAIG SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:SCOTT
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 1:1178 SHONTO WAY
Mailing Address - Street 2:
Mailing Address - City:IVINS
Mailing Address - State:UT
Mailing Address - Zip Code:84738-6347
Mailing Address - Country:US
Mailing Address - Phone:435-674-2593
Mailing Address - Fax:
Practice Address - Street 1:1178 SHONTO WAY
Practice Address - Street 2:
Practice Address - City:IVINS
Practice Address - State:UT
Practice Address - Zip Code:84738-6347
Practice Address - Country:US
Practice Address - Phone:435-674-2593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT378658-1205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine