Provider Demographics
NPI:1548449952
Name:PAYNE, PHILEEMON ERIC (MD)
Entity type:Individual
Prefix:
First Name:PHILEEMON
Middle Name:ERIC
Last Name:PAYNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 FROSTWOOD DR
Mailing Address - Street 2:SUITE 690
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2314
Mailing Address - Country:US
Mailing Address - Phone:713-461-8866
Mailing Address - Fax:
Practice Address - Street 1:920 FROSTWOOD DR
Practice Address - Street 2:SUITE 690
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2314
Practice Address - Country:US
Practice Address - Phone:713-461-8866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3986208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery