Provider Demographics
NPI:1922008846
Name:WINWARD, TRACY W (MD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:W
Last Name:WINWARD
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 1:295 S 1470 E STE 200
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-1762
Mailing Address - Country:US
Mailing Address - Phone:435-628-1662
Mailing Address - Fax:435-628-1722
Practice Address - Street 1:295 S 1470 E STE 200
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-1762
Practice Address - Country:US
Practice Address - Phone:435-628-1662
Practice Address - Fax:435-628-1722
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT185467-1205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD0567Medicaid
UTF86795Medicare UPIN
UT003805005Medicare ID - Type Unspecified