MEDICARE: CHARLES FRANKLIN PAYNE D.O.

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	207Q00000X	Family Medicine Physician	OS5369	FL
2	207Q00000X	Family Medicine Physician	1435	AZ

General Provider Information

NPI Number	:	1770752206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES FRANKLIN PAYNE D.O.

Provider Business Mailing Address
First Line	:	9325 OSPREY ISLES BLVD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33412-1118
Country	:	US
Telephone Number	:	561-799-9938
Fax Number	:	561-799-9938

Provider Business Practice Location Address
First Line	:	9325 OSPREY ISLES BLVD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33412-1118
Country	:	US
Telephone Number	:	561-799-9938
Fax Number	:	561-799-9938

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2008
Last Update Date	:	02/28/2008

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