Provider Demographics
NPI:1790401115
Name:PAYTON, DAMIEN A
Entity Type:Individual
Prefix:
First Name:DAMIEN
Middle Name:A
Last Name:PAYTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 BELLEFONTAINE AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64130-3954
Mailing Address - Country:US
Mailing Address - Phone:913-667-0600
Mailing Address - Fax:816-800-9219
Practice Address - Street 1:6201 BELLEFONTAINE AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64130-3954
Practice Address - Country:US
Practice Address - Phone:913-667-0600
Practice Address - Fax:816-800-9219
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOS116188044172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver