Basic Information
| Provider Information | |||||||||
| NPI: | 1699738476 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUNYON | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | PAUL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4380 MALSBARY RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452425644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133664488 | ||||||||
| FaxNumber: | 5133664480 | ||||||||
| Practice Location | |||||||||
| Address1: | 2123 AUBURN AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452192906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137218881 | ||||||||
| FaxNumber: | 5132875805 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2006 | ||||||||
| LastUpdateDate: | 05/19/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 35053033 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 00000196937 | 01 | OH | ANTHEM CLINTON COUNTY | OTHER | 2520384 | 01 | UNITED | OTHER | 64862147 | 05 | KY | MEDICAID | 000000205152 | 01 | OH | ANTHEM CINCINNATI | OTHER | 0744261 | 05 | OH | MEDICAID | 311438871036 | 01 | OH | CARESOURCE | OTHER | 284915 | 01 | AMERIGROUP | OTHER | 53033-08 | 01 | HUMANA | OTHER | 000000196937 | 01 | OH | ANTHEM MIDDLETOWN | OTHER | 06550099 | 01 | AETNA | OTHER |