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General NPI Number Information
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NPI Number | 1346468238
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Entity Type | Individual
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Provider Name | LARRY PAYTON PA-C
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Gender | Male
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 01/04/2011
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Provider Practice Location Address
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Address Line | 100 BREWSTER BLVD NAVAL HOSPITAL
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City | CAMP LEJEUNE
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State | NC
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Zip | 28547-2538
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Country | US
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Telephone | 910-450-3905
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Fax | 910-450-4558
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Provider Business Mailing Address
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Address Line | 100 BREWSTER BLVD NAVAL HOSPITAL
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City | CAMP LEJEUNE
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State | NC
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Zip | 28547-2538
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Country | US
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Telephone | 910-450-3905
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Fax | 910-450-4558
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 000177-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 269
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00250100
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License Number State | NJ
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