Provider Demographics
NPI:1225348840
Name:PAYNE, LANOR EARL
Entity Type:Individual
Prefix:MR
First Name:LANOR
Middle Name:EARL
Last Name:PAYNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N 17TH ST
Mailing Address - Street 2:203
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-2336
Mailing Address - Country:US
Mailing Address - Phone:314-261-3538
Mailing Address - Fax:
Practice Address - Street 1:210 N 17TH ST
Practice Address - Street 2:203
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103-2336
Practice Address - Country:US
Practice Address - Phone:314-261-3538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator