Provider Demographics
NPI:1073616249
Name:BAYNE, EVERETT E (MD)
Entity Type:Individual
Prefix:
First Name:EVERETT
Middle Name:E
Last Name:BAYNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ROLLING HILLS LN
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-9488
Mailing Address - Country:US
Mailing Address - Phone:580-310-0312
Mailing Address - Fax:580-310-0326
Practice Address - Street 1:800 ROLLING HILLS LN
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-9488
Practice Address - Country:US
Practice Address - Phone:580-310-0312
Practice Address - Fax:580-310-0326
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK152632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKE41727Medicare UPIN