Healthcare Provider Details

I. General information

NPI: 1912283102
Provider Name (Legal Business Name): JOSHUA EDISON PAYNE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2011
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3433 NW 56TH ST STE 660
OKLAHOMA CITY OK
73112-4449
US

IV. Provider business mailing address

3433 NW 56TH ST STE 660
OKLAHOMA CITY OK
73112-4449
US

V. Phone/Fax

Practice location:
  • Phone: 405-948-4040
  • Fax:
Mailing address:
  • Phone: 405-948-4040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number28721
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number28721
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number28721
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: