Provider Demographics
NPI:1609889963
Name:WINTER, FRED DAVID JR (MD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:DAVID
Last Name:WINTER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3434 SWISS AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-6251
Mailing Address - Country:US
Mailing Address - Phone:214-828-0010
Mailing Address - Fax:214-828-0014
Practice Address - Street 1:3434 SWISS AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-6251
Practice Address - Country:US
Practice Address - Phone:214-828-0010
Practice Address - Fax:214-828-0014
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2008-07-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE4771207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131580603Medicaid
TX87X752OtherBCBS
TX87X752OtherBCBS
TXC23677Medicare UPIN
TX131580603Medicaid