Provider Demographics
NPI:1356306864
Name:PAYNE, ERIC ALAN (MD)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:ALAN
Last Name:PAYNE
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 1:38177 HIGHWAY 1055
Mailing Address - Street 2:
Mailing Address - City:MOUNT HERMON
Mailing Address - State:LA
Mailing Address - Zip Code:70450-7023
Mailing Address - Country:US
Mailing Address - Phone:985-322-2073
Mailing Address - Fax:985-322-2076
Practice Address - Street 1:2020 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FRANKLINTON
Practice Address - State:LA
Practice Address - Zip Code:70438-2533
Practice Address - Country:US
Practice Address - Phone:985-322-2073
Practice Address - Fax:985-322-2076
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD11643R207R00000X
LA11643R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1492507Medicaid
LAG6438OtherBLUECROSS BLUESHIELD
4F401CM53Medicare PIN
LAG6438OtherBLUECROSS BLUESHIELD
G61174Medicare UPIN
LA5Y915D060Medicare PIN
LA5Y915D060Medicare PIN