Provider Demographics
NPI:1548440845
Name:TONY A. PAYSON, M.D., P.A.
Entity type:Organization
Organization Name:TONY A. PAYSON, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAYSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-772-6770
Mailing Address - Street 1:PO BOX 21659
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76702-1659
Mailing Address - Country:US
Mailing Address - Phone:254-772-6770
Mailing Address - Fax:254-772-8471
Practice Address - Street 1:213A OLD HEWITT RD
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6647
Practice Address - Country:US
Practice Address - Phone:254-772-6770
Practice Address - Fax:254-772-8471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG54672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161211101Medicaid
TX161211101Medicaid