Provider Demographics
NPI:1760976708
Name:VINYARD INSTITUTE OF PLASTIC SURGERY LLC
Entity Type:Organization
Organization Name:VINYARD INSTITUTE OF PLASTIC SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:WINYARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-244-7254
Mailing Address - Street 1:151 MANOR CIR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-1642
Mailing Address - Country:US
Mailing Address - Phone:913-244-7254
Mailing Address - Fax:
Practice Address - Street 1:291 NW PEACOCK BLVD STE 104
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2214
Practice Address - Country:US
Practice Address - Phone:913-244-7254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME120069208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME120069OtherMEDICAL LICENSE