Basic Information
| Provider Information | |||||||||
| NPI: | 1285849646 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCUNE | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 311 CAMDEN ST | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782152012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104550167 | ||||||||
| FaxNumber: | 2104550169 | ||||||||
| Practice Location | |||||||||
| Address1: | 311 CAMDEN ST | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782152012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104550167 | ||||||||
| FaxNumber: | 2104550169 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2007 | ||||||||
| LastUpdateDate: | 10/03/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | LL16287 | OR | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2085R0202X | 28093 | OR | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | N6488 | TX | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.