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General NPI Number Information
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NPI Number | 1073705166
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Entity Type | Organization
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Legal Business Name | OTIS EDD PAYNE, M.D.,PS
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 08/13/2007
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Provider Practice Location Address
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Address Line | 18015 53RD AVE NE
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City | LAKE FOREST PARK
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State | WA
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Zip | 98155-4361
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Country | US
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Telephone | 206-427-2171
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Fax | 425-670-8293
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Provider Business Mailing Address
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Address Line | 18015 53RD AVE NE
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City | LAKE FOREST PARK
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State | WA
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Zip | 98155-4361
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Country | US
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Telephone | 206-427-2171
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Fax | 425-670-8293
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. OTIS EDD PAYNE
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Credential | M.D.
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Telephone | 206-427-2171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD00010587
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License Number State | WA
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