Provider Demographics
NPI:1609261684
Name:STATKEWICZ, PAYTON LAVELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:PAYTON
Middle Name:LAVELLE
Last Name:STATKEWICZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6701 AIRPORT BLVD STE A101
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-6767
Mailing Address - Country:US
Mailing Address - Phone:251-378-6209
Mailing Address - Fax:251-378-6222
Practice Address - Street 1:75 S UNIVERSITY BLVD STE 6000-A
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3042
Practice Address - Country:US
Practice Address - Phone:251-660-5787
Practice Address - Fax:251-660-5559
Is Sole Proprietor?:No
Enumeration Date:2015-04-06
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL35546207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program