Provider Demographics
NPI:1043261506
Name:WINSLOW, PAUL L III (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:L
Last Name:WINSLOW
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1649 W EAU GALLIE BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-4160
Mailing Address - Country:US
Mailing Address - Phone:321-622-5650
Mailing Address - Fax:321-622-5645
Practice Address - Street 1:1649 W EAU GALLIE BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-4160
Practice Address - Country:US
Practice Address - Phone:321-622-5650
Practice Address - Fax:321-622-5645
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91061207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270780200Medicaid
48530WMedicare PIN
FL270780200Medicaid