Individual
KENNAN THOMAS RUNTE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
123 MARGARET LANE, STE B-1, GRASS VALLEY, CA 95945
(530) 477-7200
(530) 477-1246
Mailing address
123 MARGARET LANE, STE B-1, GRASS VALLEY, CA 95945
(530) 477-7200
(530) 477-1246
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
E37870
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
E38771
—
CA
01
—
ZZZ06288Z
BS
—
Enumeration date
03/02/2006
Last updated
07/08/2007
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