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General NPI Number Information
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NPI Number | 1881691335
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Entity Type | Individual
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Provider Name | PAUL EDGAR RUNGE MD
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Gender | Male
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Dates
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Enumeration Date | 06/30/2005
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Last Update Date | 12/27/2023
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Provider Practice Location Address
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Address Line | 13411 BLYTHEFIELD TER
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-2456
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Country | US
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Telephone | 941-894-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 13411 BLYTHEFIELD TER
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-2456
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Country | US
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Telephone | 941-894-4400
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME58780
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number | A39159
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A39159
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 19486
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License Number State | TN
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