Healthcare Provider Details

I. General information

NPI: 1093869851
Provider Name (Legal Business Name): TIMOTHY C. RUNYON, D.P.M. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 16TH ST N
ST. PETERSBURG FL
33704-4123
US

IV. Provider business mailing address

1401 16TH ST N
ST. PETERSBURG FL
33704-4123
US

V. Phone/Fax

Practice location:
  • Phone: 727-894-0794
  • Fax: 727-895-1215
Mailing address:
  • Phone: 727-894-0794
  • Fax: 727-895-1215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License NumberPO1101
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberPO1101
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO1101
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPO1101
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberPO1101
License Number StateFL
# 6
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: DR. KYLE C KINMON
Title or Position: PROVIDER/OWNER
Credential: DPM
Phone: 561-995-0229