Provider Demographics
NPI:1306833173
Name:VANWINKLE, LLOYD P (MD)
Entity Type:Individual
Prefix:DR
First Name:LLOYD
Middle Name:P
Last Name:VANWINKLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LLOYD
Other - Middle Name:P
Other - Last Name:VAN WINKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:409 MADRID ST
Mailing Address - Street 2:
Mailing Address - City:CASTROVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78009-4527
Mailing Address - Country:US
Mailing Address - Phone:830-538-2254
Mailing Address - Fax:830-931-2259
Practice Address - Street 1:409 MADRID ST
Practice Address - Street 2:
Practice Address - City:CASTROVILLE
Practice Address - State:TX
Practice Address - Zip Code:78009-4527
Practice Address - Country:US
Practice Address - Phone:830-538-2254
Practice Address - Fax:830-931-2259
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
TXG3878207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110501704Medicaid
TX9135LCOtherBCBS
TXTXB104619OtherPTAN
TX8A0550OtherBCBS
TXB27241Medicare UPIN
TX8A0550OtherBCBS