Doctor Name: | RICHARD JACKSON PAYNE |
NPI Number: | 1245235092 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | K1617 |
Business Practice Address: | 2602 Saint Michael Dr Suite 301 Texarkana, TX - 755032387 |
Business Phone Number: | 9036145258 |
Business Fax Number: | 9036145260 |
Mailing Address: | 2602 Saint Michael Dr, Suite 301 TEXARKANA |
State: | TX |
Postal Code: | 755032387 |
Phone Number: | 9036145258 |
Fax Number: | 9036145260 |
NPI Enumeration Date: | 06/17/2005 |
NPI Last Update Date: | 07/15/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | K1617 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |