Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0900X | Dermatopathologist | 00006700 | AL |
NPI | 1134264872 |
---|---|
Provider Name | Dr. R Rex Payne |
First Address | Birmingham, AL 35235-3400 |
Second Address | Birmingham, AL 35235-3400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2007 |
Last Update Date | 17/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000078860 | (05) | AL |
051078860 | BC BS OF ALABAMA (01) | AL |
C71882 | (02) | AL |