Individual
MR. ERIC O PAYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1421 N STATE ST, SUITE 203, JACKSON, MS 39202-1658
(601) 355-1234
(601) 326-3559
Mailing address
1421 N STATE ST STE 203, JACKSON, MS 39202-1658
(601) 355-1234
(601) 326-3559
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R871191
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07636002
—
MS
01
—
P00882999
RR MEDICIARE
MS
Enumeration date
08/31/2006
Last updated
05/15/2014
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