Individual
JOHN C PAYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
555 E BROADWAY AVE STE 211, JACKSON, WY 83001-8640
(307) 739-7618
(307) 734-0077
Mailing address
PO BOX 428, JACKSON, WY 83001-0428
(307) 739-7618
(307) 734-0077
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
6651A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117561100
—
WY
Enumeration date
03/15/2007
Last updated
01/18/2021
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