Individual
CHARLES LEE PAYNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
970 W BROADWAY # 378, JACKSON, WY 83001-9475
(307) 734-6956
Mailing address
970 W BROADWAY # 378, JACKSON, WY 83001-9475
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
40735
CO
Other
Enumeration date
02/14/2006
Last updated
08/29/2007
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