Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DN10201 | FL |
Y | 213EG0000X | General Practice | DN10201 | FL |
NPI | 1003919036 |
---|---|
Provider Name | Michael C Winter |
First Address | Ponte Vedra, FL 32082 |
Second Address | Ponte Vedra, FL 32082 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
656344 | TRICARE (01) | |
656344 | UC (01) |