Healthcare Provider Details

I. General information

NPI: 1710389580
Provider Name (Legal Business Name): ERIC THOMAS PAYNE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 KUHL AVE
ORLANDO FL
32806-2024
US

IV. Provider business mailing address

1705 KUHL AVE
ORLANDO FL
32806-2024
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-8588
  • Fax: 321-841-8560
Mailing address:
  • Phone: 321-841-8588
  • Fax: 321-841-8560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number58161
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number58161
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: