Provider Demographics
NPI:1639211147
Name:PAYTON, TOBI LYNN (PAC)
Entity Type:Individual
Prefix:MS
First Name:TOBI
Middle Name:LYNN
Last Name:PAYTON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MRS
Other - First Name:TOBI
Other - Middle Name:LYNN
Other - Last Name:PAYTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PAC
Mailing Address - Street 1:18701 N 67TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-7100
Mailing Address - Country:US
Mailing Address - Phone:623-561-7222
Mailing Address - Fax:
Practice Address - Street 1:18701 N 67TH AVENUE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308
Practice Address - Country:US
Practice Address - Phone:623-882-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2256207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ462333Medicaid
AZ860373636OtherHUMANA GROUP #
AZAW1436OtherHEALTHNET GRP #
AZ453051001OtherGROUP HEALTH GRP #
AZ3981220OtherEVERCARE GRP #