Healthcare Provider Details

I. General information

NPI: 1538256417
Provider Name (Legal Business Name): RALPH E PAYNE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 CALHOUN ST
COLUMBIA SC
29201-2607
US

IV. Provider business mailing address

1516 CALHOUN ST
COLUMBIA SC
29201-2607
US

V. Phone/Fax

Practice location:
  • Phone: 803-254-6116
  • Fax: 803-254-7674
Mailing address:
  • Phone: 803-254-6116
  • Fax: 803-254-7674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number052
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: