Provider Demographics
NPI:1477747772
Name:BRUCE L. WINTER M.D. P.A.
Entity Type:Organization
Organization Name:BRUCE L. WINTER M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:210-377-0350
Mailing Address - Street 1:2929 MOSSROCK
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-5141
Mailing Address - Country:US
Mailing Address - Phone:210-377-0350
Mailing Address - Fax:210-377-2982
Practice Address - Street 1:2929 MOSSROCK
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-5141
Practice Address - Country:US
Practice Address - Phone:210-377-0350
Practice Address - Fax:210-377-2982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152016502Medicaid
TX177732801Medicaid
8F0564Medicare PIN
00110ZMedicare PIN
TX177732801Medicaid