Doctor Name: | JONATHAN B RUNION |
NPI Number: | 1134308984 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA |
License Number: | PA 9101816 |
Business Practice Address: | 13020 N Telecom Pkwy Temple Terrace, FL - 336370925 |
Business Phone Number: | 8139789700 |
Business Fax Number: | |
Mailing Address: | 13020 N Telecom Pkwy, TEMPLE TERRACE |
State: | FL |
Postal Code: | 336370925 |
Phone Number: | 8139789700 |
Fax Number: | |
NPI Enumeration Date: | 10/29/2007 |
NPI Last Update Date: | 09/21/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AS0400X |
License Number: | PA 9101816 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Surgical |
Taxonomy Definition: |