Individual
GERALD GENE PAYNE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1600 W COLLEGE ST, STE 210, GRAPEVINE, TX 76051-3580
(817) 481-0111
(817) 481-0112
Mailing address
PO BOX 100186, FORT WORTH, TX 76185-0186
(817) 731-7771
(817) 731-7774
Taxonomy
Speciality
Code
Description
License number
State
207VM0101X
Maternal & Fetal Medicine Physician
Primary
G3678
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
135806109
—
TX
05
—
135806110
—
TX
05
—
135806115
—
TX
01
—
4292523
AETNA
TX
01
—
74999
AMERIGROUP
TX
01
—
8H3361
BCBS
TX
Enumeration date
02/22/2006
Last updated
02/10/2022
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