Provider Demographics
NPI:1851407431
Name:BLISS, WINSTON O (MD)
Entity Type:Individual
Prefix:DR
First Name:WINSTON
Middle Name:O
Last Name:BLISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:4101 NW 4TH ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2850
Mailing Address - Country:US
Mailing Address - Phone:954-522-2979
Mailing Address - Fax:954-903-0633
Practice Address - Street 1:4101 NW 4TH ST
Practice Address - Street 2:SUITE 306
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2850
Practice Address - Country:US
Practice Address - Phone:954-522-2979
Practice Address - Fax:954-903-0633
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71138207V00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252056700Medicaid
FLG60861Medicare UPIN