Provider Demographics
NPI:1720024276
Name:PAYNE, IRINA EDWARDOVNA (MD)
Entity Type:Individual
Prefix:DR
First Name:IRINA
Middle Name:EDWARDOVNA
Last Name:PAYNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 WOODFORD WAY
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-6445
Mailing Address - Country:US
Mailing Address - Phone:405-285-0497
Mailing Address - Fax:
Practice Address - Street 1:100 MCDOUGAL DR
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:HOLDENVILLE
Practice Address - State:OK
Practice Address - Zip Code:74848-2822
Practice Address - Country:US
Practice Address - Phone:405-379-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22402207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKI02417Medicare UPIN