Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 3165 | OR |
Y | 103T00000X | Psychologist | 3165 | OR |
NPI | 1013455435 |
---|---|
Provider Name | Benjamin Paynter |
First Address | Springfield, OR 97477-2594 |
Second Address | Springfield, OR 97477-2594 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2017 |
Last Update Date | 13/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
500775973 | (05) | OR |