Basic Information
| Provider Information | |||||||||
| NPI: | 1578554184 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IACUONE | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5865 | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794085865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067432898 | ||||||||
| FaxNumber: | 8067432787 | ||||||||
| Practice Location | |||||||||
| Address1: | 6630 QUAKER AVE | ||||||||
| Address2: | SUITE I | ||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794135900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067437337 | ||||||||
| FaxNumber: | 8067432314 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2005 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0207X | E7627 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology |
ID Information
| ID | Type | State | Issuer | Description | P0030946 | 01 | TX | DPS | OTHER | 87516Z | 01 | TX | HMO BLUE | OTHER | 18029 | 05 | NM | MEDICAID | D002 | 01 | NM | TRIWEST | OTHER | 89C160 | 01 | TX | BC/BS | OTHER | AI7515224 | 01 | TX | DEA | OTHER | 18029 | 01 | NM | PRESBYTERIAN COMMERCIAL | OTHER | U3067 | 05 | NM | MEDICAID |