Provider Demographics
NPI:1356014831
Name:WINDERS, STEVEN GORDON (SOIDC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:GORDON
Last Name:WINDERS
Suffix:
Gender:M
Credentials:SOIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 SW PLANTATION DR
Mailing Address - Street 2:
Mailing Address - City:MAPLE HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28454-7588
Mailing Address - Country:US
Mailing Address - Phone:619-817-6140
Mailing Address - Fax:
Practice Address - Street 1:273 SW PLANTATION DR
Practice Address - Street 2:
Practice Address - City:MAPLE HILL
Practice Address - State:NC
Practice Address - Zip Code:28454-7588
Practice Address - Country:US
Practice Address - Phone:619-817-6140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
12192611SW1710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman