Individual
SAMUEL DUSTIN PAYNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1820 E 17TH ST STE 330, IDAHO FALLS, ID 83404-6400
(208) 497-0685
Mailing address
555 W MIKAN DR APT 12202, REXBURG, ID 83440-8056
(208) 760-5688
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
06/07/2025
Last updated
06/07/2025
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