Individual
JEREMY ROY PAYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD,PHD
Contact information
Practice address
1215 N BEAVER ST, FLAGSTAFF, AZ 86001-3120
(928) 773-2200
Mailing address
1200 N BEAVER ST, PAYER CREDENTIALING, FLAGSTAFF, AZ 86001-3118
(928) 213-6235
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
35163
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112222
—
AZ
01
—
P00331961
RAILROAD MEDICARE
AZ
Enumeration date
05/17/2006
Last updated
08/22/2022
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