Provider Demographics
NPI:1538360284
Name:PAYNE, KEVIN S (DO, MPH)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:S
Last Name:PAYNE
Suffix:
Gender:M
Credentials:DO, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 COTTONWOOD CT
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-7605
Mailing Address - Country:US
Mailing Address - Phone:202-714-3101
Mailing Address - Fax:
Practice Address - Street 1:625 COOLIDGE DR STE 100
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3197
Practice Address - Country:US
Practice Address - Phone:202-714-3101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01022021132083P0500X
CA20A142822083P0500X
MTMED-PHYS-LIC-596402083P0500X, 2083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine