Individual
MICHAEL ERIC PAYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
500 W THOMAS RD STE 800, PHOENIX, AZ 85013-4217
(602) 406-1234
(602) 406-6368
Mailing address
PO BOX 33269, PHOENIX, AZ 85067-3269
(602) 406-2665
(916) 636-4358
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
5267
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5267
ARIZONA STATE BOARD LICENSE
AZ
05
—
763691
—
AZ
Enumeration date
11/27/2012
Last updated
12/06/2024
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