Provider Demographics
NPI:1679177661
Name:TIMOTHY C. RUNYON, D.P.M. P.A.
Entity Type:Organization
Organization Name:TIMOTHY C. RUNYON, D.P.M. P.A.
Other - Org Name:CERTIFIED FOOT AND ANKLE SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:KINMON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-995-0229
Mailing Address - Street 1:12681 NEW BRITTANY BLVD # 1E
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3631
Mailing Address - Country:US
Mailing Address - Phone:239-689-3843
Mailing Address - Fax:239-689-3852
Practice Address - Street 1:12681 NEW BRITTANY BLVD # 1E
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3631
Practice Address - Country:US
Practice Address - Phone:239-689-3843
Practice Address - Fax:239-689-3852
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TIMOTHY C. RUNYON, D.P.M. P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-30
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty