Provider Demographics
NPI:1629117031
Name:WINTER, CORNELIA PATRICIA (MD,)
Entity Type:Individual
Prefix:MRS
First Name:CORNELIA
Middle Name:PATRICIA
Last Name:WINTER
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 FOX HALL LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-2120
Mailing Address - Country:US
Mailing Address - Phone:210-332-3760
Mailing Address - Fax:
Practice Address - Street 1:400 CONCORD PLAZA DR
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6905
Practice Address - Country:US
Practice Address - Phone:210-396-5350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2910207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000N64E8Medicaid
TX00N64EMedicare ID - Type Unspecified
TXC23676Medicare UPIN