Provider Demographics
NPI:1477618221
Name:WINTER, RANDY DONNELL (MD)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:DONNELL
Last Name:WINTER
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 1:1400 FLORIDA AVE
Mailing Address - Street 2:STE. 207
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4422
Mailing Address - Country:US
Mailing Address - Phone:209-522-1027
Mailing Address - Fax:209-522-7956
Practice Address - Street 1:1400 FLORIDA AVE
Practice Address - Street 2:STE. 207
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4422
Practice Address - Country:US
Practice Address - Phone:209-522-1027
Practice Address - Fax:209-522-7956
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG60601207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAYYY34301YMedicare ID - Type Unspecified
CAE34157Medicare UPIN