Provider Demographics
NPI:1144214636
Name:WINDHAM, MARION RAY (MD)
Entity Type:Individual
Prefix:MR
First Name:MARION
Middle Name:RAY
Last Name:WINDHAM
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Gender:M
Credentials:MD
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Mailing Address - Street 1:81767 DR CARREON BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-5597
Mailing Address - Country:US
Mailing Address - Phone:760-775-4181
Mailing Address - Fax:760-775-4818
Practice Address - Street 1:74990 COUNTRY CLUB DR
Practice Address - Street 2:SUITE 310
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-1991
Practice Address - Country:US
Practice Address - Phone:760-341-8800
Practice Address - Fax:760-775-4818
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2017-01-19
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Provider Licenses
StateLicense IDTaxonomies
CAC34630208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA88998Medicare UPIN
CA00C346300Medicare PIN