Individual
JACK D RUNYAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA, PHD
Contact information
Practice address
734 W COMMERCE ST, FAIRFIELD, TX 75840
(956) 572-4000
Mailing address
734 W COMMERCE ST, FAIRFIELD, TX 75840-1428
(903) 389-2181
(903) 389-0901
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA 01154
TX
Other
Enumeration date
12/22/2008
Last updated
08/07/2018
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