Provider Demographics
NPI:1871505412
Name:PAYNE, DARREN (MD)
Entity Type:Individual
Prefix:
First Name:DARREN
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 1:1600 JENKS AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4644
Mailing Address - Country:US
Mailing Address - Phone:850-763-6666
Mailing Address - Fax:850-763-6665
Practice Address - Street 1:1600 JENKS AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4644
Practice Address - Country:US
Practice Address - Phone:850-763-6666
Practice Address - Fax:850-763-6665
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88113207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268988000Medicaid
FL0827170001Medicare PIN
FL268988000Medicaid
FLU2192ZMedicare PIN
GAP00117749Medicare PIN