Provider Demographics
NPI:1538256417
Name:PAYNE, RALPH E (DPM)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:E
Last Name:PAYNE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 CALHOUN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2607
Mailing Address - Country:US
Mailing Address - Phone:803-254-6116
Mailing Address - Fax:803-254-7674
Practice Address - Street 1:1516 CALHOUN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2607
Practice Address - Country:US
Practice Address - Phone:803-254-6116
Practice Address - Fax:803-254-7674
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC052213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT23691747Medicare ID - Type UnspecifiedPROVIDER NUMBER