Organization Name: | TIMOTHY C. RUNYON, D.P.M. P.A. |
NPI Number: | 1093869851 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TIMOTHY C RUNYON (PROVIDER/OWNER) |
Mailing Address: | 1401 16th St N St. Petersburg |
State: | FL US |
Postal Code: | 337044123 |
Phone Number: | 7278940794 |
Fax Number: | 7278951215 |
NPI Enumeration Date: | 01/22/2007 |
NPI Last Update Date: | 03/10/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0000X |
License Number: | PO1101 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | FL |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Sports Medicine |
Taxonomy Definition: |