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General NPI Number Information
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NPI Number | 1245430594
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Entity Type | Organization
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Legal Business Name | MICHAEL D PAYNE MD PLLC PA
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Dates
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Enumeration Date | 07/24/2007
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Last Update Date | 05/03/2011
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Provider Practice Location Address
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Address Line | 200 N CLIFTON ST
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City | FORDYCE
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State | AR
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Zip | 71742-3027
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Country | US
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Telephone | 870-352-3151
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Fax | 870-352-8497
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Provider Business Mailing Address
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Address Line | 200 N CLIFTON ST
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City | FORDYCE
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State | AR
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Zip | 71742-3027
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Country | US
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Telephone | 870-352-3151
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Fax | 870-352-8497
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL D PAYNE II
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Credential | M.D.
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Telephone | 870-352-3151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | E3409
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License Number State | AR
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