Provider Demographics
NPI:1437535077
Name:HEAD, WINTHROP T
Entity Type:Individual
Prefix:
First Name:WINTHROP
Middle Name:T
Last Name:HEAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 W HARVARD AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-2756
Mailing Address - Country:US
Mailing Address - Phone:541-672-7546
Mailing Address - Fax:541-957-8446
Practice Address - Street 1:1813 W HARVARD AVE STE 310
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-2756
Practice Address - Country:US
Practice Address - Phone:541-672-7546
Practice Address - Fax:541-957-8446
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical