Healthcare Provider Details

I. General information

NPI: 1114145778
Provider Name (Legal Business Name): SARAH ANN PAYNE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH ANN GATZA D.O.

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13640 N PLAZA DEL RIO BLVD
PEORIA AZ
85381-4846
US

IV. Provider business mailing address

13640 N PLAZA DEL RIO BLVD
PEORIA AZ
85381-4846
US

V. Phone/Fax

Practice location:
  • Phone: 623-876-3800
  • Fax: 623-972-9590
Mailing address:
  • Phone: 623-876-3800
  • Fax: 623-972-9590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number5337
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101016398
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: