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General NPI Number Information
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NPI Number | 1588854145
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Entity Type | Organization
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Legal Business Name | STARFIGHTER, LLC.
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Dates
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Enumeration Date | 07/30/2007
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Last Update Date | 07/31/2007
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Provider Practice Location Address
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Address Line | 1501 W 24TH ST
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City | YUMA
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State | AZ
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Zip | 85364-6370
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Country | US
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Telephone | 928-344-2000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1070
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City | YUMA
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State | AZ
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Zip | 85366-1070
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Country | US
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Telephone | 928-726-4234
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Fax | 928-726-4241
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Authorized Official
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Title or Position | OWNER
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Name | DONALD WAYNE RUNYAN
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Credential | DO
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Telephone | 928-726-4234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PE0005X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
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License Number | 3599
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License Number State | AZ
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