1780691949 NPI number — GARY CHARLES PAYNE DPM

Table of content: GARY CHARLES PAYNE DPM (NPI 1780691949)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780691949 NPI number — GARY CHARLES PAYNE DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAYNE
Provider First Name:
GARY
Provider Middle Name:
CHARLES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1780691949
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12833B RESEARCH BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78750-3200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-249-2253
Provider Business Mailing Address Fax Number:
512-258-2109

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12833B RESEARCH BLVD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-249-2253
Provider Business Practice Location Address Fax Number:
512-258-2109
Provider Enumeration Date:
08/01/2006

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: 213E00000X , with the licence number:  0536 , 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)

  • Identifier: 018830201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11011766 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4464150001 . This is a "PALMETTO GBA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 741891053 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: T15205 . This is a "COMMERCIAL CARRIERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: DPM536 . This is a "CMI WALMART" identifier . This identifiers is of the category "OTHER".
  • Identifier: DPM536 . This is a "AIG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00T800 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 480900054 . This is a "UNITED HEALTH CARE RAIL R" identifier . This identifiers is of the category "OTHER".




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