Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 5101016398 | MI |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 5337 | AZ |
NPI | 1114145778 |
---|---|
Provider Name | Dr. Sarah Ann Payne |
First Address | Peoria, AZ 85381-4846 |
Second Address | Peoria, AZ 85381-4846 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2007 |
Last Update Date | 05/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
465324 | (05) | AZ |