Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RS0012X | Sleep Medicine | 40591 | MN |
N | 2084N0400X | Neurologist | 40591 | MN |
N | 2084N0600X | Clinical Neurophysiologist | 40591 | MN |
NPI | 1083682561 |
---|---|
Provider Name | Troy A Payne |
First Address | St Cloud, MN 56303 |
Second Address | St Cloud, MN 56303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2006 |
Last Update Date | 30/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
998517400 | (05) | MN |
G84259 | (02) |