Healthcare Provider Details

I. General information

NPI: 1699738476
Provider Name (Legal Business Name): JOHN PAUL RUNYON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 11/29/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 AUBURN AVE
CINCINNATI OH
45219-2906
US

IV. Provider business mailing address

4380 MALSBARY RD SUITE 200
CINCINNATI OH
45242-5644
US

V. Phone/Fax

Practice location:
  • Phone: 513-721-8881
  • Fax: 513-287-5805
Mailing address:
  • Phone: 513-366-4488
  • Fax: 513-366-4480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35053033
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: