Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 15-00302 | KS |
NPI | 1083742191 |
---|---|
Provider Name | Virgina T Runyan |
First Address | Wichita, KS 67214-2810 |
Second Address | Wichita, KS 67214-2810 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q63019 | (02) | KS |