Provider Demographics
NPI:1629078779
Name:WIN, JOSEPHINE T (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPHINE
Middle Name:T
Last Name:WIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JOSEPHINE
Other - Middle Name:T
Other - Last Name:WIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2097 N COLLINS BLVD
Mailing Address - Street 2:#198
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-2691
Mailing Address - Country:US
Mailing Address - Phone:972-680-9983
Mailing Address - Fax:972-680-9163
Practice Address - Street 1:2097 N COLLINS BLVD
Practice Address - Street 2:#198
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2691
Practice Address - Country:US
Practice Address - Phone:972-680-9983
Practice Address - Fax:972-680-9163
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ46778207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F70801Medicare UPIN
TX00780FMedicare ID - Type Unspecified