Provider Demographics
NPI:1114018819
Name:WINTERTON, JOHN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:WINTERTON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1717 OAK PARK BLVD
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8991
Mailing Address - Country:US
Mailing Address - Phone:337-494-3278
Mailing Address - Fax:337-494-3240
Practice Address - Street 1:1717 OAK PARK BLVD
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8991
Practice Address - Country:US
Practice Address - Phone:337-494-3278
Practice Address - Fax:337-494-3240
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA20942207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1915840Medicaid
LA5N737F942Medicare PIN
LA060067071Medicare PIN
LAF03428Medicare UPIN