Provider Demographics
NPI:1932134871
Name:WINTER, JON R (DO)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:R
Last Name:WINTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:TN
Mailing Address - Zip Code:38320-1617
Mailing Address - Country:US
Mailing Address - Phone:731-584-3141
Mailing Address - Fax:731-584-3143
Practice Address - Street 1:145 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:TN
Practice Address - Zip Code:38320-1617
Practice Address - Country:US
Practice Address - Phone:731-584-3141
Practice Address - Fax:731-584-3143
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN824207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNE14510Medicare UPIN