Provider Demographics
NPI:1417279035
Name:PAYNE, ADAM JOHN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:JOHN
Last Name:PAYNE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 GLASSON WAY
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5706
Mailing Address - Country:US
Mailing Address - Phone:530-272-2303
Mailing Address - Fax:530-272-9648
Practice Address - Street 1:126 GLASSON WAY
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5706
Practice Address - Country:US
Practice Address - Phone:530-272-2303
Practice Address - Fax:530-272-9648
Is Sole Proprietor?:No
Enumeration Date:2010-02-23
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20851363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant