Provider Demographics
NPI:1487639183
Name:PAYNE, DOUGLAS (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:PAYNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79522208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB104323OtherPTAN
TXN1054OtherTEXAS MEDICAL BOARD
CA00A79522OtherMEDICAL LICENSE