Basic Information
| Provider Information | |||||||||
| NPI: | 1801241658 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ERIC RUNYON, D.O., P.A. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | RDBO | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11760 SW 40TH ST | ||||||||
| Address2: | SUITE 654 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331753582 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7866156123 | ||||||||
| FaxNumber: | 7866156103 | ||||||||
| Practice Location | |||||||||
| Address1: | 11760 SW 40TH ST | ||||||||
| Address2: | SUITE 654 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331753582 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7866156123 | ||||||||
| FaxNumber: | 7866156103 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2016 | ||||||||
| LastUpdateDate: | 04/29/2016 | ||||||||
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| AuthorizedOfficialLastName: | KNICKERBOKER | ||||||||
| AuthorizedOfficialFirstName: | CLAUDIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7866156123 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | OS8317 | FL | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | OS4300 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.