Provider Demographics
NPI:1710243399
Name:PAYNE, JOSHUA MARK (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:MARK
Last Name:PAYNE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 N TARRANT PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-8629
Mailing Address - Country:US
Mailing Address - Phone:817-885-7827
Mailing Address - Fax:
Practice Address - Street 1:2450 OAK HILL CIR
Practice Address - Street 2:APT 225
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-9508
Practice Address - Country:US
Practice Address - Phone:806-282-2076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-08
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXQ9474207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program