Provider Demographics
NPI:1417070715
Name:PAINE, MICHAEL HURD (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:HURD
Last Name:PAINE
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:PO BOX 108822
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73101-8822
Mailing Address - Country:US
Mailing Address - Phone:970-385-2364
Mailing Address - Fax:
Practice Address - Street 1:575 RIVERGATE LANE
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7487
Practice Address - Country:US
Practice Address - Phone:970-385-2364
Practice Address - Fax:970-385-2396
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43059207PH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PH0002XAllopathic & Osteopathic PhysiciansEmergency MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO90359046Medicaid
COC20133Medicare UPIN
CO90359046Medicaid