1881691335 NPI number — DR. PAUL EDGAR RUNGE MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881691335 NPI number — DR. PAUL EDGAR RUNGE MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

RUNGE

Provider First Name:

PAUL

Provider Middle Name:

EDGAR

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1881691335

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

12/27/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

13411 BLYTHEFIELD TER

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

LAKEWOOD RANCH

Provider Business Mailing Address State Name:

FL

Provider Business Mailing Address Postal Code:

34202-2456

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

941-894-4400

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

13411 BLYTHEFIELD TER

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

LAKEWOOD RANCH

Provider Business Practice Location Address State Name:

FL

Provider Business Practice Location Address Postal Code:

34202-2456

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

941-894-4400

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

06/30/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207W00000X , with the licence number:  ME58780 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207WX0107X , with the licence number: A39159 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 208000000X , with the licence number: A39159 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207W00000X , with the licence number: 19486 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0805726 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 31874 . This is a "BCBS/FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 379992100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
• Identifier: 3488212-001 . This is a "CIGNA PAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 0401145 . This is a "GHI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: ME0058780 . This is a "FL LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 4197868 . This is a "AETNA PPO, MC, EC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 0927003 . This is a "AETNA HMO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 024431500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".