Provider Demographics
NPI:1356303788
Name:RUNYAN, JOHN LUTHER (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LUTHER
Last Name:RUNYAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 GLENN AVE SUITE 303
Mailing Address - Street 2:MEDICAL PROFESSIONAL BUILDING
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815
Mailing Address - Country:US
Mailing Address - Phone:570-784-6077
Mailing Address - Fax:570-784-1676
Practice Address - Street 1:410 GLENN AVE SUITE 303
Practice Address - Street 2:MEDICAL PROFESSIONAL BUILDING
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815
Practice Address - Country:US
Practice Address - Phone:570-784-6077
Practice Address - Fax:570-784-1676
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003949L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009310150004Medicaid
PA01005201OtherCBC
PA01005201OtherCBC
PA0009310150004Medicaid