Healthcare Provider Details

I. General information

NPI: 1932411998
Provider Name (Legal Business Name): BRIAN SCOTT PAYNE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2010
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 INDIANA AVENUE DIVISION OF PEDIATRIC EMERGENCY MEDICINE
LUBBOCK TX
79415
US

IV. Provider business mailing address

1465 S GRAND BLVD DIVISION OF PEDIATRIC EMERGENCY MEDICINE
SAINT LOUIS MO
63104-1003
US

V. Phone/Fax

Practice location:
  • Phone: 68-775-9700
  • Fax:
Mailing address:
  • Phone: 314-577-5360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2013012532
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberQ7450
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberQ7450
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: