Provider Demographics
NPI:1629245931
Name:PAYNE, LOUIS T (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:T
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 1:535 JACK WARNER PARKWAY NE
Mailing Address - Street 2:SUITE I
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404
Mailing Address - Country:US
Mailing Address - Phone:205-556-2026
Mailing Address - Fax:205-554-0584
Practice Address - Street 1:535 JACK WARNER PARKWAY NE
Practice Address - Street 2:SUITE I
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404
Practice Address - Country:US
Practice Address - Phone:205-556-2026
Practice Address - Fax:205-554-0584
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3505207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000085253Medicaid
AL000085253Medicaid