Provider Demographics
NPI:1821832932
Name:PAYNE, DWIGHT LAVON
Entity type:Individual
Prefix:
First Name:DWIGHT
Middle Name:LAVON
Last Name:PAYNE
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 1:1715 JILLIAN RD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-2215
Mailing Address - Country:US
Mailing Address - Phone:813-606-2113
Mailing Address - Fax:
Practice Address - Street 1:1715 JILLIAN RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-2215
Practice Address - Country:US
Practice Address - Phone:813-605-2113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company