MEDICARE: DR. JONATHAN NEAL RUNYON MD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	2080P0203X	Pediatric Critical Care Medicine Physician	ME144468	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699209965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN NEAL RUNYON MD

Provider Business Mailing Address
First Line	:	1117 E HALLANDALE BEACH BLVD
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-4488
Country	:	US
Telephone Number	:	954-454-5131
Fax Number	:	954-261-6908

Provider Business Practice Location Address
First Line	:	1005 JOE DIMAGGIO DR
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-5487
Country	:	US
Telephone Number	:	954-265-6301
Fax Number	:	954-985-1434

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

Provider Enumeration Date	:	04/13/2017
Last Update Date	:	08/02/2023

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