Provider Demographics
NPI:1083603047
Name:WINZENRIED, JAY A (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:A
Last Name:WINZENRIED
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 1:721 SHERIDAN AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-3436
Mailing Address - Country:US
Mailing Address - Phone:307-527-7100
Mailing Address - Fax:307-527-7145
Practice Address - Street 1:721 SHERIDAN AVE STE 130
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-3436
Practice Address - Country:US
Practice Address - Phone:307-527-7100
Practice Address - Fax:307-527-7145
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6422A207X00000X
WY4931310001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0065059Medicaid
WY486921300OtherFEDERAL WORK COMP
WY115812100Medicaid
WYP00096957OtherRAILROAD MEDICARE
WY312326OtherBLUE CROSS BLUE SHEILD
WY4931310001OtherDMERC
WY115812101OtherMEDICAID DME
WY4931310001Medicare NSC
WYP00096957Medicare PIN
WY9801Medicare ID - Type Unspecified
WY115812100Medicaid