1528390630 NPI number — MR. WAYNE ALTON PAYTON I LMT, MMP, RMP

Table of content: MR. WAYNE ALTON PAYTON I LMT, MMP, RMP (NPI 1528390630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528390630 NPI number — MR. WAYNE ALTON PAYTON I LMT, MMP, RMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAYTON
Provider First Name:
WAYNE
Provider Middle Name:
ALTON
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
I
Provider Credential Text:
LMT, MMP, RMP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528390630
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8436 KINCAID LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRISCO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75036-0976
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-718-4177
Provider Business Mailing Address Fax Number:
972-780-9992

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 STONEBROOK PKWY UNIT 404
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75036-1181
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-718-4177
Provider Business Practice Location Address Fax Number:
972-780-9992
Provider Enumeration Date:
02/01/2010

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: 172M00000X , with the licence number:  MT039221 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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