Provider Demographics
NPI:1700077427
Name:RUNYAN, PAUL (PA-C)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:RUNYAN
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 1:24900 HIGHWAY 202
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93561
Mailing Address - Country:US
Mailing Address - Phone:661-822-4402
Mailing Address - Fax:
Practice Address - Street 1:234 BAKER ST
Practice Address - Street 2:SUITE 1&2
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93305-5856
Practice Address - Country:US
Practice Address - Phone:661-322-7580
Practice Address - Fax:661-322-7712
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12566363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant