Provider Demographics
NPI:1942218003
Name:PAYNE, JANE GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:GREGORY
Last Name:PAYNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:
Other - Last Name:GREGORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3810 SE DIVISION ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1641
Mailing Address - Country:US
Mailing Address - Phone:503-208-2207
Mailing Address - Fax:503-487-3938
Practice Address - Street 1:3810 SE DIVISION ST
Practice Address - Street 2:SUITE C
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1641
Practice Address - Country:US
Practice Address - Phone:503-208-2207
Practice Address - Fax:503-487-3938
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD257312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR141323Medicare PIN
OR272524Medicare PIN