Provider Demographics
NPI:1417213844
Name:PAYNE, RUSSELL (MD)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:
Last Name:PAYNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5012 S US HIGHWAY 75 STE 300
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-4589
Mailing Address - Country:US
Mailing Address - Phone:903-416-6065
Mailing Address - Fax:903-416-6068
Practice Address - Street 1:5012 S US HIGHWAY 75 STE 300
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-4589
Practice Address - Country:US
Practice Address - Phone:903-416-6065
Practice Address - Fax:903-416-6068
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXS2458207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program