Provider Demographics
NPI:1760845473
Name:PAYNE, NATHAN BRIAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:BRIAN
Last Name:PAYNE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 MARGARET LN STE A
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5261
Mailing Address - Country:US
Mailing Address - Phone:801-368-0512
Mailing Address - Fax:530-648-1235
Practice Address - Street 1:104 MARGARET LN STE A
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5261
Practice Address - Country:US
Practice Address - Phone:801-368-0512
Practice Address - Fax:530-648-1235
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5539213ES0103X
MI5315078221213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty