Provider Demographics
NPI:1578566360
Name:WINEGAR, JAMES BRYSTON (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BRYSTON
Last Name:WINEGAR
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:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-0009
Mailing Address - Country:US
Mailing Address - Phone:423-857-2066
Mailing Address - Fax:423-857-2070
Practice Address - Street 1:153 ROSS CARTER BLVD
Practice Address - Street 2:
Practice Address - City:DUFFIELD
Practice Address - State:VA
Practice Address - Zip Code:24244
Practice Address - Country:US
Practice Address - Phone:276-431-2648
Practice Address - Fax:276-431-2082
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD 13274207Q00000X
VA0101031442207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5641594Medicaid
VA005641594Medicaid
TN3185817Medicaid
KY64116692Medicaid
KY64116692Medicaid
VA005641594Medicaid
VAC03412Medicare PIN
VA080019138Medicare PIN
VA080003803Medicare PIN
B04209Medicare UPIN
VA080003803Medicare ID - Type Unspecified
TN0281780003Medicare PIN
TN0281780001Medicare PIN
VAC06181Medicare PIN
VA080007184Medicare PIN
TN103I086169Medicare UPIN
TN3185817Medicaid