Provider Demographics
NPI:1619953171
Name:RUNYAN, NEMA SENOL (MD)
Entity type:Individual
Prefix:DR
First Name:NEMA
Middle Name:SENOL
Last Name:RUNYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 E BROWN RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-5226
Mailing Address - Country:US
Mailing Address - Phone:480-649-9000
Mailing Address - Fax:
Practice Address - Street 1:2310 E BROWN RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213-5226
Practice Address - Country:US
Practice Address - Phone:480-649-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79973207R00000X
AZ56649207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263394900Medicaid
FLH50299Medicare UPIN