Provider Demographics
NPI:1518964238
Name:RUNYON, DAVID WAYNE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:WAYNE
Last Name:RUNYON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 SE 17TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5519
Mailing Address - Country:US
Mailing Address - Phone:352-732-7779
Mailing Address - Fax:352-732-2664
Practice Address - Street 1:2750 SE 17TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5519
Practice Address - Country:US
Practice Address - Phone:352-732-7779
Practice Address - Fax:352-732-2664
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV838363AS0400X
FLPA9109546207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022138600Medicaid
FLIQ891ZOtherMEDICARE