Provider Demographics
NPI:1710092580
Name:WINSOR, DAVID WILEY (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WILEY
Last Name:WINSOR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2131 W 3RD ST
Mailing Address - Street 2:ST VINCENT MEDICAL CENTER DEPT OF NUCLEAR MEDICINE
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-1901
Mailing Address - Country:US
Mailing Address - Phone:213-484-7991
Mailing Address - Fax:213-484-7444
Practice Address - Street 1:2131 W 3RD ST
Practice Address - Street 2:ST VINCENT MEDICAL CENTER DEPT OF NUCLEAR MEDICINE
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-1901
Practice Address - Country:US
Practice Address - Phone:213-484-7991
Practice Address - Fax:213-484-7444
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG15320207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHG15320Medicare ID - Type Unspecified
CAA90379Medicare UPIN