Healthcare Provider Details

I. General information

NPI: 1740230697
Provider Name (Legal Business Name): MR. WARRENSON A PAYNE
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 HOLCOMBE BLVD MICHAEL E. DEBAKEY VA MEDICAL CENTER
HOUSTON TX
77030
US

IV. Provider business mailing address

7443 CASTLEVIEW LN
MISSOURI CITY TX
77489-2426
US

V. Phone/Fax

Practice location:
  • Phone: 713-791-1414
  • Fax: 713-794-7094
Mailing address:
  • Phone: 281-438-0013
  • Fax: 713-794-7094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA01582
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA01582
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA01582
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: