Provider Demographics
NPI:1699120949
Name:PAYNE, JON (MD)
Entity type:Individual
Prefix:
First Name:JON
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 1:5501 GORDON SMITH DR STE 500
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-3209
Mailing Address - Country:US
Mailing Address - Phone:214-703-8100
Mailing Address - Fax:214-703-3269
Practice Address - Street 1:5501 GORDON SMITH DR STE 500
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75089-3209
Practice Address - Country:US
Practice Address - Phone:214-703-8100
Practice Address - Fax:214-703-3269
Is Sole Proprietor?:No
Enumeration Date:2016-04-24
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR9267207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine