Provider Demographics
NPI:1588825566
Name:PAYNE, WILLIAM SIMON CLARKE (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:SIMON CLARKE
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 1:3300 S. PARKER RD.
Mailing Address - Street 2:SUITE 404
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014
Mailing Address - Country:US
Mailing Address - Phone:720-974-7149
Mailing Address - Fax:720-974-7175
Practice Address - Street 1:5657 S HIMALAYA ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-5307
Practice Address - Country:US
Practice Address - Phone:303-699-6200
Practice Address - Fax:720-460-4783
Is Sole Proprietor?:No
Enumeration Date:2008-06-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.097154208000000X
CO51182208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO54236223Medicaid
OHH001460Medicare PIN