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NPI Code Detail

MEDICARE: DR. BRANDON RUNYAN M.D.

MEDICARE: DR. BRANDON RUNYAN M.D.
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
12085R0202XDiagnostic Radiology Physician81990GA

General Provider Information

NPI Number : 1225012198
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRANDON RUNYAN M.D.
Provider Business Mailing Address
First Line : 2600 WESTHALL LN STE 4
Second Line :
City : MAITLAND
State : FL
Zip : 32751-7102
Country : US
Telephone Number : 407-200-2355
Fax Number :
Provider Business Practice Location Address
First Line : 725 JESSE JEWELL PKWY SE
Second Line :
City : GAINESVILLE
State : GA
Zip : 30501-3834
Country : US
Telephone Number : 770-535-9391
Fax Number : 770-533-4701
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2005
Last Update Date : 02/10/2026

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