MEDICARE: DARREN PAYNE, M.D., LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center	ME88113	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164882726
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DARREN PAYNE, M.D., LLC

Provider Business Mailing Address
First Line	:	PO BOX 641538
Second Line	:
City	:	BEVERLY HILLS
State	:	FL
Zip	:	34464-1538
Country	:	US
Telephone Number	:	850-240-2205
Fax Number	:

Provider Business Practice Location Address
First Line	:	3402 N LECANTO HWY
Second Line	:
City	:	BEVERLY HILLS
State	:	FL
Zip	:	34465-3570
Country	:	US
Telephone Number	:	850-240-2205
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. DARREN PAYNE
Credential	:	M.D.
Telephone Number	:	850-240-2205

Provider Enumeration Date	:	02/25/2016
Last Update Date	:	02/25/2016

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