Provider Demographics
NPI:1922195452
Name:PAYNE, DARREN (DPM)
Entity Type:Individual
Prefix:DR
First Name:DARREN
Middle Name:
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 1:555 MARIN ST
Mailing Address - Street 2:SUITE 290
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-4112
Mailing Address - Country:US
Mailing Address - Phone:805-497-6979
Mailing Address - Fax:
Practice Address - Street 1:555 MARIN ST
Practice Address - Street 2:SUITE 290
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-4112
Practice Address - Country:US
Practice Address - Phone:805-497-6979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4294213ES0103X
UT5626927-0501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU81713Medicare UPIN
CA000E42940Medicare ID - Type Unspecified