Provider Demographics
NPI:1366422123
Name:PAYSON, TONY A (MD)
Entity type:Individual
Prefix:
First Name:TONY
Middle Name:A
Last Name:PAYSON
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 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG54672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113424905Medicaid
TX113424905Medicaid