Healthcare Provider Details

I. General information

NPI: 1528399714
Provider Name (Legal Business Name): MATTHEW AARON PAYNE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2010
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3321 W 11TH AVE
EUGENE OR
97402-3040
US

IV. Provider business mailing address

3321 W 11TH AVE
EUGENE OR
97402-3040
US

V. Phone/Fax

Practice location:
  • Phone: 541-222-7200
  • Fax:
Mailing address:
  • Phone: 541-222-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601005692
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA169146
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: