Healthcare Provider Details

I. General information

NPI: 1902168552
Provider Name (Legal Business Name): ISAAC CHRISTOPHER PAYNE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 06/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 MOBILE INFIRMARY CIR STE 305
MOBILE AL
36607-3515
US

IV. Provider business mailing address

3 MOBILE INFIRMARY CIR STE 305
MOBILE AL
36607-3515
US

V. Phone/Fax

Practice location:
  • Phone: 251-433-5557
  • Fax:
Mailing address:
  • Phone: 251-433-5557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberDO1385
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: