1295804284 NPI number — DR. GERALDINE STEWART PAYNE M.D.

Table of content: DOMINIC LUJAN (NPI 1316593684)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295804284 NPI number — DR. GERALDINE STEWART PAYNE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAYNE
Provider First Name:
GERALDINE
Provider Middle Name:
STEWART
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SEASTRUNK
Provider Other First Name:
GERALDINE
Provider Other Middle Name:
PAYNE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295804284
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8574
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANDEVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70470-8574
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-674-1399
Provider Business Mailing Address Fax Number:
985-626-3253

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 N CAUSEWAY BLVD
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
MANDEVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70448-4646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-674-1399
Provider Business Practice Location Address Fax Number:
985-626-3253
Provider Enumeration Date:
11/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  9794 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0804X , with the licence number: 9794 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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