MEDICARE: DR. RICHARD DUANE RUNYAN JR. PH.D.

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
1	103TC0700X	Clinical Psychologist	PY0386	NV

General Provider Information

NPI Number	:	1497809651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD DUANE RUNYAN JR. PH.D.

Provider Business Mailing Address
First Line	:	1001 MOUNTAIN ST STE 3H
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89703-3812
Country	:	US
Telephone Number	:	775-445-7756
Fax Number	:	775-841-0304

Provider Business Practice Location Address
First Line	:	1001 MOUNTAIN ST STE 3H
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89703-3812
Country	:	US
Telephone Number	:	775-445-7756
Fax Number	:	775-841-0304

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	07/08/2007

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