Provider Demographics
NPI:1316287121
Name:BEAN, PAYTON LEE (RVT, RDCS, RT (R))
Entity type:Individual
Prefix:
First Name:PAYTON
Middle Name:LEE
Last Name:BEAN
Suffix:
Gender:M
Credentials:RVT, RDCS, RT (R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 11TH STREET
Mailing Address - Street 2:
Mailing Address - City:PLAINS
Mailing Address - State:TX
Mailing Address - Zip Code:79355
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:820 N ELKHART AVE
Practice Address - Street 2:A
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-1195
Practice Address - Country:US
Practice Address - Phone:806-773-1877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX156934246XS1301X
TX4581602471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Single Specialty
No2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Single Specialty