Provider Demographics
NPI:1760492193
Name:PAYNE, DAVID (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
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:PO BOX 465
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92781-0465
Mailing Address - Country:US
Mailing Address - Phone:714-479-0840
Mailing Address - Fax:714-836-5237
Practice Address - Street 1:1530 E 1ST ST
Practice Address - Street 2:SUITE 216
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-6342
Practice Address - Country:US
Practice Address - Phone:714-479-0840
Practice Address - Fax:714-836-5237
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62826207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G628261Medicaid
CA135499OtherDEPT OF LABOR
CAG62826BMedicare ID - Type Unspecified
CA00G628261Medicaid