1215911524 NPI number — FRANK CORRY PAYNE III MD

Table of content: FRANK CORRY PAYNE III MD (NPI 1215911524)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215911524 NPI number — FRANK CORRY PAYNE III MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAYNE
Provider First Name:
FRANK
Provider Middle Name:
CORRY
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PAYNE
Provider Other First Name:
F
Provider Other Middle Name:
CORRY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
III
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1215911524
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7115 GREENVILLE AVENUE
Provider Second Line Business Mailing Address:
SUITE 310
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-265-3200
Provider Business Mailing Address Fax Number:
214-265-3292

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7115 GREENVILLE AVENUE
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-265-3200
Provider Business Practice Location Address Fax Number:
214-265-3292
Provider Enumeration Date:
11/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 204C00000X , with the licence number:  F4359 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: F4359 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207XX0005X , with the licence number: F4359 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8BZ907 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 752130698 . This is a "TAX ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 035484702 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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