Provider Demographics
NPI:1083893309
Name:PAISLEY, PEYTON A (MD)
Entity Type:Individual
Prefix:
First Name:PEYTON
Middle Name:A
Last Name:PAISLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 DENNY AVE
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39581-5301
Mailing Address - Country:US
Mailing Address - Phone:228-809-5510
Mailing Address - Fax:228-809-5510
Practice Address - Street 1:2018 BROOKWOOD MEDICAL CTR DR STE 311
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6870
Practice Address - Country:US
Practice Address - Phone:205-877-2707
Practice Address - Fax:205-877-2917
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20224207R00000X
IN01066861A207R00000X, 208M00000X
ALMD27831207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200953990Medicaid
IN000000624783OtherANTHEM PIN
IN267030SSMedicare PIN
INP00740653Medicare PIN
IN165460G5Medicare PIN
IN200953990Medicaid