Provider Demographics
NPI:1043229305
Name:PAYNE, ELIZABETH E (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:E
Last Name:PAYNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 W. CITRACADO PARKWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-6428
Mailing Address - Country:US
Mailing Address - Phone:760-746-2641
Mailing Address - Fax:760-740-2178
Practice Address - Street 1:625 W. CITRACADO PARKWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-6428
Practice Address - Country:US
Practice Address - Phone:760-746-2641
Practice Address - Fax:760-740-2178
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74067208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF70817Medicare UPIN