Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | F4359 | TX |
Y | 207X00000X | Orthopaedic Surgeon | F4359 | TX |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | F4359 | TX |
NPI | 1215911524 |
---|---|
Provider Name | Frank Corry Payne III |
First Address | Dallas, TX 75231 |
Second Address | Dallas, TX 75231 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2005 |
Last Update Date | 08/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
035484702 | (05) | TX |
752130698 | TAX ID (01) | TX |
8BZ907 | BCBS (01) | TX |
C20325 | (02) | TX |