Provider Demographics
NPI:1700828027
Name:RUNYAN, BRAD C (MD)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:C
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 1:1214 RUE CT
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-3847
Mailing Address - Country:US
Mailing Address - Phone:970-217-8861
Mailing Address - Fax:
Practice Address - Street 1:4575 BYRD DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-7198
Practice Address - Country:US
Practice Address - Phone:970-593-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35264174400000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01352640Medicaid
COC446778OtherMEDICARE PTAN
COC446778OtherMEDICARE PTAN