Provider Demographics
NPI:1457487027
Name:WINGER, EDWARD EVAN (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:EVAN
Last Name:WINGER
Suffix:
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:P.O. BOX 3622
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048
Mailing Address - Country:US
Mailing Address - Phone:916-704-3871
Mailing Address - Fax:505-358-7324
Practice Address - Street 1:611 WASHINGTON ST
Practice Address - Street 2:2106
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-2105
Practice Address - Country:US
Practice Address - Phone:415-291-7341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2017-03-21
Deactivation Date:2016-12-14
Deactivation Code:
Reactivation Date:2017-03-21
Provider Licenses
StateLicense IDTaxonomies
CAA023374207ZI0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZI0100XAllopathic & Osteopathic PhysiciansPathologyImmunopathology