Provider Demographics
NPI:1821045287
Name:PAYNE, ERIK J (MD)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:J
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:PO BOX 35145 #40023
Mailing Address - Street 2:
Mailing Address - City:COEUR D'ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:98124-5145
Mailing Address - Country:US
Mailing Address - Phone:425-407-1500
Mailing Address - Fax:425-407-1112
Practice Address - Street 1:101 W IRONWOOD DR STE 250
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-1415
Practice Address - Country:US
Practice Address - Phone:208-765-8585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT0483612207L00000X
MA227425207L00000X
IDM-9979207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology