MEDICARE: DR. WENDY JADE PAYNE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	6943577-1205	UT

General Provider Information

NPI Number	:	1386977171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WENDY JADE PAYNE MD

Provider Business Mailing Address
First Line	:	4907 NORTH 300 WEST
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604
Country	:	US
Telephone Number	:	801-705-8040
Fax Number	:	801-765-5740

Provider Business Practice Location Address
First Line	:	4907 NORTH 300 WEST
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604
Country	:	US
Telephone Number	:	801-705-8040
Fax Number	:	801-765-5740

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2009
Last Update Date	:	09/13/2012

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