Provider Demographics
NPI:1225006109
Name:WINTER, THOMAS C III (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:C
Last Name:WINTER
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 1:1627 MOHAWK WAY
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-3311
Mailing Address - Country:US
Mailing Address - Phone:801-585-6108
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF UTAH DEPARTMENT OF RADIOLOGY
Practice Address - Street 2:30 NORTH 1900 EAST #1A071
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-581-7553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6992880-12052085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32557300Medicaid
WI32557300Medicaid
063415875Medicare ID - Type Unspecified