Organization
OTIS EDD PAYNE, M.D.,PS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OTIS EDD PAYNE M.D. (PRESIDENT)
(206) 427-2171
Entity
Organization
Contact information
Practice address
18015 53RD AVE NE, LAKE FOREST PARK, WA 98155-4361
(206) 427-2171
(425) 670-8293
Mailing address
18015 53RD AVE NE, LAKE FOREST PARK, WA 98155-4361
(206) 427-2171
(425) 670-8293
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD00010587
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1199009
—
WA
01
—
G8801577
MEDICARE GROUP
WA
Enumeration date
08/13/2007
Last updated
08/13/2007
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