Provider Demographics
NPI:1780887026
Name:PAYNE, MISTY M (MD)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:M
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:PO BOX 72059
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97475-0285
Mailing Address - Country:US
Mailing Address - Phone:541-222-6915
Mailing Address - Fax:541-222-6908
Practice Address - Street 1:123 INTERNATIONAL WAY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-1047
Practice Address - Country:US
Practice Address - Phone:541-222-6915
Practice Address - Fax:541-222-6908
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM9940207ZC0500X, 207ZP0102X
ORMD160393207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology