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NPI Code Detail

MEDICARE: RYAN T RUNYON DO

MEDICARE:   RYAN T RUNYON  DO
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
1207Q00000XFamily Medicine Physician2005WV

Other Identifiers

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

General Provider Information

NPI Number : 1932115938
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN T RUNYON DO
Provider Business Mailing Address
First Line : PO BOX 1589
Second Line :
City : PRINCETON
State : WV
Zip : 24740-1589
Country : US
Telephone Number : 304-431-7100
Fax Number : 304-431-7112
Provider Business Practice Location Address
First Line : 904 HARRISON ST
Second Line :
City : PRINCETON
State : WV
Zip : 24740-3011
Country : US
Telephone Number : 304-431-7100
Fax Number : 304-431-7112
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2006
Last Update Date : 12/28/2009

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Directions to “ RYAN T RUNYON DO” Practice Location

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