Provider Demographics
NPI:1881691335
Name:RUNGE, PAUL EDGAR (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:EDGAR
Last Name:RUNGE
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 1:13411 BLYTHEFIELD TER
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-2456
Mailing Address - Country:US
Mailing Address - Phone:941-894-4400
Mailing Address - Fax:
Practice Address - Street 1:13411 BLYTHEFIELD TER
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-2456
Practice Address - Country:US
Practice Address - Phone:941-894-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58780207W00000X
CAA39159207WX0107X, 208000000X
TN19486207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0805726OtherUNITED HEALTHCARE
FL31874OtherBCBS/FL
FL379992100Medicaid
FL3488212-001OtherCIGNA PAL
FL0401145OtherGHI
FLME0058780OtherFL LICENSE
FL4197868OtherAETNA PPO, MC, EC
FL0927003OtherAETNA HMO
FL31874OtherBCBS/FL
FLME0058780OtherFL LICENSE
FLE12691Medicare UPIN