Provider Demographics
NPI:1619064367
Name:WINSTON, BOB (MD)
Entity Type:Individual
Prefix:DR
First Name:BOB
Middle Name:
Last Name:WINSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:234 RUE BEAUREGARD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3285
Mailing Address - Country:US
Mailing Address - Phone:337-593-0830
Mailing Address - Fax:337-593-0122
Practice Address - Street 1:234 RUE BEAUREGARD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3285
Practice Address - Country:US
Practice Address - Phone:337-593-0830
Practice Address - Fax:337-593-0122
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA11569R2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1672025Medicaid
LA1672025Medicaid
LA5W564Medicare ID - Type Unspecified