Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 2017018442 | MO |
NPI | 1013446137 |
---|---|
Provider Name | Robert Scott Runyon |
First Address | St. Louis, MO 63110 |
Second Address | St. Louis, MO 63110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2017 |
Last Update Date | 12/06/2017 |