Provider Demographics
NPI:1962480137
Name:WINTER, JERROLD A (MD)
Entity Type:Individual
Prefix:DR
First Name:JERROLD
Middle Name:A
Last Name:WINTER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3709 N CAMPBELL AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-1563
Mailing Address - Country:US
Mailing Address - Phone:520-838-3148
Mailing Address - Fax:520-838-2260
Practice Address - Street 1:2404 E RIVER RD
Practice Address - Street 2:BLD 2 STE100
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-6520
Practice Address - Country:US
Practice Address - Phone:520-696-4780
Practice Address - Fax:520-293-7024
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2018-02-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ9892207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ201947Medicaid
AZZ121804Medicare PIN
AZ201947Medicaid
A53664Medicare UPIN