Provider Demographics
NPI:1699738476
Name:RUNYON, JOHN PAUL (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:RUNYON
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 1:4380 MALSBARY RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-5644
Mailing Address - Country:US
Mailing Address - Phone:513-366-4488
Mailing Address - Fax:513-366-4480
Practice Address - Street 1:2123 AUBURN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-721-8881
Practice Address - Fax:513-287-5805
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35053033207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00000196937OtherANTHEM CLINTON COUNTY
2520384OtherUNITED
OH000000205152OtherANTHEM CINCINNATI
OH0744261Medicaid
OH311438871036OtherCARESOURCE
284915OtherAMERIGROUP
KY64862147Medicaid
53033-08OtherHUMANA
OH000000196937OtherANTHEM MIDDLETOWN
06550099OtherAETNA
OH0744261Medicaid
OH4087983Medicare PIN
2520384OtherUNITED