MEDICARE: TIMOTHY C. RUNYON, DPM, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist
2	332900000X	Non-Pharmacy Dispensing Site

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023784188
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIMOTHY C. RUNYON, DPM, PA

Provider Business Mailing Address
First Line	:	1401 16TH ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33704-4123
Country	:	US
Telephone Number	:	727-894-0794
Fax Number	:

Provider Business Practice Location Address
First Line	:	2540 WINKLER AVE
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9338
Country	:	US
Telephone Number	:	239-278-4100
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KYLE J KINMON
Credential	:
Telephone Number	:	561-995-0229

Provider Enumeration Date	:	08/19/2021
Last Update Date	:	10/09/2024

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