Individual
DR. THERESA BLAINE BAKER PAYNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
180 NW HAYNES ST, MADISON, FL 32340-2010
(850) 973-1215
(866) 923-4163
Mailing address
PO BOX 185, MADISON, FL 32341-0185
(850) 973-1215
(866) 926-4163
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
OS9255
FL
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
OS9255
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
272752800
—
FL
01
—
P00281257
RAILROAD MEDICARE
FL
Enumeration date
08/12/2006
Last updated
06/30/2016
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