Provider Demographics
NPI:1649416108
Name:GREGORY N PAYNE, MD, PA
Entity Type:Organization
Organization Name:GREGORY N PAYNE, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGEORY
Authorized Official - Middle Name:N
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-235-5951
Mailing Address - Street 1:107 PRAIRIE LN
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-7347
Mailing Address - Country:US
Mailing Address - Phone:903-235-5951
Mailing Address - Fax:903-663-5821
Practice Address - Street 1:107 PRAIRIE LN
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-7347
Practice Address - Country:US
Practice Address - Phone:903-235-5951
Practice Address - Fax:903-663-5821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX J5622207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty