Healthcare Provider Details

I. General information

NPI: 1467477133
Provider Name (Legal Business Name): JAMES RICHARD PAYNE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1334 NELSON AVE
MODESTO CA
95350-5341
US

IV. Provider business mailing address

4301 N STAR WAY
MODESTO CA
95356-9262
US

V. Phone/Fax

Practice location:
  • Phone: 209-524-9904
  • Fax: 209-524-4101
Mailing address:
  • Phone: 209-345-2300
  • Fax: 209-524-4240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG45465
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: