Provider Demographics
NPI:1629127121
Name:PAYSEUR, GARNETT STEPHON (MD)
Entity Type:Individual
Prefix:
First Name:GARNETT
Middle Name:STEPHON
Last Name:PAYSEUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:G
Other - Middle Name:STEPHON
Other - Last Name:PAYSEUR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:9301 N CENTRAL EXPY STE 180
Mailing Address - Street 2:TWR II
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-0821
Mailing Address - Country:US
Mailing Address - Phone:214-253-0202
Mailing Address - Fax:214-253-0203
Practice Address - Street 1:9301 N CENTRAL EXPY STE 180
Practice Address - Street 2:TWR II
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-0821
Practice Address - Country:US
Practice Address - Phone:214-253-0202
Practice Address - Fax:214-253-0203
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5202207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0976490003Medicaid
TX378096YQKSMedicare PIN
TX097649002Medicaid