Provider Demographics
NPI:1447311998
Name:MCCUNE, CHARLES F
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:F
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 1:21940 N 79TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-2146
Mailing Address - Country:US
Mailing Address - Phone:623-487-1812
Mailing Address - Fax:623-487-1883
Practice Address - Street 1:21940 N 79TH AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-2146
Practice Address - Country:US
Practice Address - Phone:623-487-1812
Practice Address - Fax:623-487-1883
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ634825332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies