Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 6215 | FL |
Y | 103TC0700X | Clinical Psychologist | 6215 | FL |
N | 103G00000X | Clinical Psychologist | 6215 | FL |
N | 103TC0700X | Clinical Psychologist | 6215 | FL |
NPI | 1003967514 |
---|---|
Provider Name | Robert Kenneth Winegar |
First Address | Sarasota, FL 34239-3600 |
Second Address | Sarasota, FL 34239-3600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2007 |
Last Update Date | 19/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
279833 | STAYWELL/HEALTHEASE/WELLC (01) | FL |
54586 | BCBS (01) | FL |
7006202 | AETNA (01) | FL |
768885700 | (05) | FL |