Provider Demographics
NPI:1720156490
Name:PAYNE, BROWNELL HILLARD (MD)
Entity type:Individual
Prefix:
First Name:BROWNELL
Middle Name:HILLARD
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 1:5 HOLLAND STE 101
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2568
Mailing Address - Country:US
Mailing Address - Phone:949-588-2190
Mailing Address - Fax:949-588-2199
Practice Address - Street 1:269 S BEVERLY DR # 511
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-3851
Practice Address - Country:US
Practice Address - Phone:323-290-0725
Practice Address - Fax:323-290-0727
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26350207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A263500Medicaid
CAA26350Medicare ID - Type Unspecified
CA00A263500Medicaid