Otis Edd Payne, M.d.,ps | |
18015 53rd Ave Ne Lake Forest Park WA 98155-4361 | |
(206) 427-2171 | |
(425) 670-8293 |
Full Name | Otis Edd Payne, M.d.,ps |
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Speciality | Psychiatry & Neurology - Psychiatry |
Location | 18015 53rd Ave Ne, Lake Forest Park, Washington |
Authorized Official Name and Position | Otis Edd Payne (PRESIDENT) |
Authorized Official Contact | 2064272171 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Otis Edd Payne, M.d.,ps 18015 53rd Ave Ne Lake Forest Park WA 98155-4361 Ph: (206) 427-2171 | Otis Edd Payne, M.d.,ps 18015 53rd Ave Ne Lake Forest Park WA 98155-4361 Ph: (206) 427-2171 |
NPI Number | 1073705166 |
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Provider Enumeration Date | 08/13/2007 |
Last Update Date | 08/13/2007 |
Identifier | Type | State | Issuer |
---|---|---|---|
1073705166 | NPI | - | NPPES |
1199009 | Medicaid | WA | |
G8801577 | Other | WA | MEDICARE GROUP |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
2084P0800X | Psychiatry & Neurology - Psychiatry | MD00010587 (Washington) | Primary |