License holder summary

OTIS EDD PAYNE M D P S C is a Medical Licensing Board - Medical Corporation licensed to practice in Indiana. The address on file for OTIS EDD PAYNE M D P S C is 3016 MISHAWAKA AVENUE, SOUTH BEND IN 46615. This licensed professional license is not current. The license was granted 11/04/1987 and expired on 01/31/2004.

Indiana

Professional Licensing Agency

OTIS EDD PAYNE M D P S C
Medical Licensing Board - Medical Corporation
License number
50003025A
Date granted
11/04/1987
Date expires
01/31/2004
Class
Medical Licensing Board - Medical Corporation
Status
Expired
Address
3016 MISHAWAKA AVENUE, SOUTH BEND IN 46615
indianalicensing.org
ID 24834155
LAST UPDATED 2024-04-10 20:35:43 UTC

This website is unaffiliated with the Professional Licensing Agency. Please verify all information directly with the relevant official government authority.

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