Provider Demographics
NPI:1770752206
Name:PAYNE, CHARLES FRANKLIN (DO)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:FRANKLIN
Last Name:PAYNE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9325 OSPREY ISLES BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33412-1118
Mailing Address - Country:US
Mailing Address - Phone:561-799-9938
Mailing Address - Fax:561-799-9938
Practice Address - Street 1:9325 OSPREY ISLES BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33412-1118
Practice Address - Country:US
Practice Address - Phone:561-799-9938
Practice Address - Fax:561-799-9938
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5369207Q00000X
AZ1435207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E20978Medicare UPIN