Provider Demographics
NPI:1689779993
Name:PAYNE, WILLIAM D (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:D
Last Name:PAYNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:420DELAWARE STREET SE, MMD 292
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-626-6100
Mailing Address - Fax:
Practice Address - Street 1:516 DELAWARE STREET SE
Practice Address - Street 2:PWB SECOND FLOOR, CLINIC 2A
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-626-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN22417208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN37-12454OtherMEDICA CHOICE
MN604794OtherARAZ
MN082982OtherFAIRVIEW
MN1009266OtherPREFERRED ONE
MNHP22196OtherHEALTH PARTNERS
MN084587600Medicaid
MN17-00026OtherMEDICA PRIMARY
MN2T102PAOtherBLUE CROSS BLUE SHIELD
MN101592OtherUCARE
MN1009266OtherPREFERRED ONE
MNHP22196OtherHEALTH PARTNERS