Provider Demographics
NPI:1023042546
Name:PAYNE, VAUGHN (MD)
Entity Type:Individual
Prefix:
First Name:VAUGHN
Middle Name:
Last Name:PAYNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 SE HILLMOOR DR
Mailing Address - Street 2:STE C-208
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7574
Mailing Address - Country:US
Mailing Address - Phone:772-337-5083
Mailing Address - Fax:772-337-5088
Practice Address - Street 1:1279 OLD ABBOTT MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-1889
Practice Address - Country:US
Practice Address - Phone:606-886-0892
Practice Address - Fax:606-886-9746
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25264207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64252646Medicaid
OH2734474Medicaid
WV0198900000Medicaid
KY64252646Medicaid
KY00788002Medicare PIN