Provider Demographics
NPI:1518110261
Name:DR MARK D WINCHESTER MD PLLC
Entity Type:Organization
Organization Name:DR MARK D WINCHESTER MD PLLC
Other - Org Name:MARK WINCHESTER, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:WINCHESTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-485-8100
Mailing Address - Street 1:PO BOX 1789
Mailing Address - Street 2:
Mailing Address - City:BLANCHARD
Mailing Address - State:OK
Mailing Address - Zip Code:73010-1789
Mailing Address - Country:US
Mailing Address - Phone:405-485-8100
Mailing Address - Fax:405-485-8104
Practice Address - Street 1:1019 N COUNCIL AVE
Practice Address - Street 2:
Practice Address - City:BLANCHARD
Practice Address - State:OK
Practice Address - Zip Code:73010-8003
Practice Address - Country:US
Practice Address - Phone:405-485-8100
Practice Address - Fax:405-485-8104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17303207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100186300AMedicaid