Provider Demographics
NPI:1306168133
Name:EL PASO MEDICAL GROUP PA
Entity type:Organization
Organization Name:EL PASO MEDICAL GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-532-6069
Mailing Address - Street 1:550 S MESA HILLS DR STE C2
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5765
Mailing Address - Country:US
Mailing Address - Phone:915-532-6069
Mailing Address - Fax:915-532-5060
Practice Address - Street 1:550 S MESA HILLS DR STE C2
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-5765
Practice Address - Country:US
Practice Address - Phone:915-532-6069
Practice Address - Fax:915-532-5060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-21
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB104323OtherPTAN
TXN1054OtherMEDICAL LICENSE