Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 100907 | NC |
NPI | 1013097963 |
---|---|
Provider Name | Mark Alan Payne |
First Address | High Point, NC 27262-4315 |
Second Address | High Point, NC 27262-4315 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 14/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R39707 | (02) |