Provider Demographics
NPI:1275545881
Name:WINSTEAD, ROBERT MARK (PA-C)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MARK
Last Name:WINSTEAD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3276 GREENWALD WAY N
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-0728
Mailing Address - Country:US
Mailing Address - Phone:407-944-0999
Mailing Address - Fax:407-935-0691
Practice Address - Street 1:3276 GREENWALD WAY N
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-0728
Practice Address - Country:US
Practice Address - Phone:407-944-0999
Practice Address - Fax:407-935-0691
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3091363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9660OtherGROUP MEDICARE #
FLE2888WMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #