Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 18524 | NV |
NPI | 1003236860 |
---|---|
Provider Name | Alec Chase Runyon |
First Address | Dallas, TX 75284-0857 |
Second Address | Las Vegas, NV 89148-1253 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2014 |
Last Update Date | 06/04/2021 |