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General NPI Number Information
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NPI Number | 1265468169
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Entity Type | Individual
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Provider Name | RUSSELL HAL MCUNE MD
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Gender | Male
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 450 E MAIN ST
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City | REXBURG
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State | ID
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Zip | 83440-2048
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Country | US
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Telephone | 208-356-3691
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 130
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City | REXBURG
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State | ID
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Zip | 83440-0130
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Country | US
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Telephone | 208-356-3691
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 01095027A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | M-15454
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD21946
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License Number State | OR
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