Provider Demographics
NPI:1205886744
Name:WINSLOW, CLINTON ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:ALAN
Last Name:WINSLOW
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 1:1230 WESTCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-1215
Mailing Address - Country:US
Mailing Address - Phone:405-810-9475
Mailing Address - Fax:
Practice Address - Street 1:4300 S SHIELDS BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73129-2864
Practice Address - Country:US
Practice Address - Phone:405-632-6681
Practice Address - Fax:405-632-6868
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14840207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100253270 BMedicaid
OK$$$$$$$$$PMedicare PIN
OK100253270 BMedicaid