Provider Demographics
NPI:1700540549
Name:TIMOTHY C. RUNYON, DPM, PA
Entity Type:Organization
Organization Name:TIMOTHY C. RUNYON, DPM, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
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 1:1401 16TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-4123
Mailing Address - Country:US
Mailing Address - Phone:727-894-0794
Mailing Address - Fax:727-895-1215
Practice Address - Street 1:923 DEL PRADO BLVD S STE 202
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3628
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, DPM, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Multi-Specialty