Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | DC19245 | CA |
NPI | 1134258825 |
---|---|
Provider Name | Dr. Anthony Michael Payan |
First Address | Pacific Grove, CA 93950-3347 |
Second Address | Pacific Grove, CA 93950-3347 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30016918 | TAT (01) | CA |
DC0192450 | BLUE SHIELD (01) | CA |
DC19254 | BLUE CROSS (01) | CA |
T91602 | (02) | CA |
ZZZ66746Z | BS GROUP # (01) | CA |