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Individual
JACK EDWARD RUNNELS
Active
Individual
JACK EDWARD RUNNELS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
2025-01850
NC
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
W8428
TX
Other
Enumeration date
03/30/2022
Last updated
09/02/2026
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