Healthcare Provider Details

I. General information

NPI: 1780887026
Provider Name (Legal Business Name): MISTY M PAYNE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 12/16/2021
Certification Date: 12/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 INTERNATIONAL WAY
SPRINGFIELD OR
97477-1047
US

IV. Provider business mailing address

PO BOX 72059
SPRINGFIELD OR
97475-0285
US

V. Phone/Fax

Practice location:
  • Phone: 541-222-6915
  • Fax: 541-222-6908
Mailing address:
  • Phone: 541-222-6915
  • Fax: 541-222-6908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberM9940
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberM9940
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberMD160393
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: