Provider Demographics
NPI:1710102173
Name:WINDER, MARK S (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:WINDER
Suffix:
Gender:M
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:PO BOX 601
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NM
Mailing Address - Zip Code:88029-0601
Mailing Address - Country:US
Mailing Address - Phone:505-531-2591
Mailing Address - Fax:
Practice Address - Street 1:32940 PERSHING ROAD
Practice Address - Street 2:
Practice Address - City:COLOMBUS
Practice Address - State:NM
Practice Address - Zip Code:88029
Practice Address - Country:US
Practice Address - Phone:505-531-2591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA49781207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology