Organization
GLADSTONE A. PAYTON, D.O.,PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLADSTONE A. PAYTON D.O. (PRESIDENT)
(586) 468-8088
Entity
Organization
Contact information
Practice address
247 NORTHBOUND GRATIOT AVE, MOUNT CLEMENS, MI 48043-5746
(586) 468-8088
Mailing address
247 NORTHBOUND GRATIOT AVE, MOUNT CLEMENS, MI 48043-5746
(586) 468-8088
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101005762
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0855018335
BLUE CROSS
MI
05
—
1003624
—
MI
Enumeration date
05/01/2007
Last updated
02/08/2008
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