Provider Demographics
NPI:1467493999
Name:RUNYAN, THOMAS E (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:RUNYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3221 GLYNN AVE
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4851
Mailing Address - Country:US
Mailing Address - Phone:912-466-9111
Mailing Address - Fax:912-466-0366
Practice Address - Street 1:3221 GLYNN AVE
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4851
Practice Address - Country:US
Practice Address - Phone:912-466-9111
Practice Address - Fax:912-466-0366
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA6400190003Medicare NSC
GAE70958Medicare UPIN
GA05BDGZPMedicare ID - Type Unspecified
GA6400190001Medicare NSC
GA6400190002Medicare NSC