MEDICARE: PAUL RUNYAN PA-C

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	363A00000X	Physician Assistant	12566	CA

General Provider Information

NPI Number	:	1700077427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL RUNYAN PA-C

Provider Business Mailing Address
First Line	:	24900 HIGHWAY 202
Second Line	:
City	:	TEHACHAPI
State	:	CA
Zip	:	93561
Country	:	US
Telephone Number	:	661-822-4402
Fax Number	:

Provider Business Practice Location Address
First Line	:	234 BAKER ST
Second Line	:	SUITE 1&2
City	:	BAKERSFIELD
State	:	CA
Zip	:	93305-5856
Country	:	US
Telephone Number	:	661-322-7580
Fax Number	:	661-322-7712

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2007
Last Update Date	:	11/08/2013

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