Provider Demographics
NPI:1013963651
Name:WINTERTON, PAUL W (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:W
Last Name:WINTERTON
Suffix:
Gender:M
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:PO BOX 211
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-0211
Mailing Address - Country:US
Mailing Address - Phone:801-561-3101
Mailing Address - Fax:
Practice Address - Street 1:96 E. KIMBALL LANE
Practice Address - Street 2:#407
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020
Practice Address - Country:US
Practice Address - Phone:801-561-3101
Practice Address - Fax:801-561-3257
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT372294-1205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005742301Medicare PIN
UTF84573Medicare UPIN