Individual
TIMOTHY PAYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1000 WALLACE WAY, GRANDVIEW, WA 98930-8805
(509) 882-3444
(509) 882-2049
Mailing address
PO BOX 190, TOPPENISH, WA 98948-0190
(509) 865-6715
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA10000956
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
127586
L & I
WA
01
—
8401655
CHPW
WA
05
—
8401655
—
WA
01
—
9022
GROUP HEALTH
—
01
—
PA6393
REGENCE
—
Enumeration date
10/05/2006
Last updated
07/08/2007
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