Provider Demographics
NPI:1194597450
Name:PAYNE, JEREMY MICHAEL
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:MICHAEL
Last Name:PAYNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 S KLEIN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-1539
Mailing Address - Country:US
Mailing Address - Phone:405-590-7448
Mailing Address - Fax:
Practice Address - Street 1:6800 S KLEIN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-1539
Practice Address - Country:US
Practice Address - Phone:405-590-7448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist