Healthcare Provider Details

I. General information

NPI: 1366475451
Provider Name (Legal Business Name): BRYAN R. PAYNE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 07/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 HAL GREER BLVD
HUNTINGTON WV
25701-3800
US

IV. Provider business mailing address

1305 ELM ST E
HUNTINGTON WV
25701-3861
US

V. Phone/Fax

Practice location:
  • Phone: 304-399-2889
  • Fax: 304-399-2881
Mailing address:
  • Phone: 304-399-2889
  • Fax: 304-399-2881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number22744
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number10052R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: