Provider Demographics
NPI:1063631661
Name:WINSLOW, CHRISTOPHER L (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:L
Last Name:WINSLOW
Suffix:
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:PO BOX 10050
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-0036
Mailing Address - Country:US
Mailing Address - Phone:870-424-5079
Mailing Address - Fax:870-424-8455
Practice Address - Street 1:911 S BAKER ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-4711
Practice Address - Country:US
Practice Address - Phone:870-508-2646
Practice Address - Fax:870-508-2644
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE 42242084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR155109001Medicaid
AR1063631661OtherNPI
AR5N028Medicare ID - Type UnspecifiedPROVIDER NUMBER
AR155109001Medicaid