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General NPI Number Information
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NPI Number | 1386865228
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Entity Type | Organization
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Legal Business Name | GLADSTONE A. PAYTON, D.O.,PC
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 02/08/2008
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Provider Practice Location Address
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Address Line | 247 NORTHBOUND GRATIOT AVE
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City | MOUNT CLEMENS
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State | MI
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Zip | 48043-5746
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Country | US
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Telephone | 586-468-8088
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Fax |
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Provider Business Mailing Address
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Address Line | 247 NORTHBOUND GRATIOT AVE
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City | MOUNT CLEMENS
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State | MI
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Zip | 48043-5746
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Country | US
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Telephone | 586-468-8088
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GLADSTONE A. PAYTON
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Credential | D.O.
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Telephone | 586-468-8088
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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 | 5101005762
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License Number State | MI
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