Provider Demographics
NPI:1154349272
Name:RUNYAN, MICHAEL CLINTON (AP)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CLINTON
Last Name:RUNYAN
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4253 COVERED CREEK CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-1444
Mailing Address - Country:US
Mailing Address - Phone:904-745-1735
Mailing Address - Fax:
Practice Address - Street 1:4253 COVERED CREEK CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-1444
Practice Address - Country:US
Practice Address - Phone:904-745-3934
Practice Address - Fax:904-745-3238
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 1395171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist