Provider Demographics
NPI:1295705903
Name:WINTERGALEN, EDWARD HENRY (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:HENRY
Last Name:WINTERGALEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:645 E MISSOURI AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1351
Mailing Address - Country:US
Mailing Address - Phone:602-262-8900
Mailing Address - Fax:602-262-8890
Practice Address - Street 1:1850 N CENTRAL AVE
Practice Address - Street 2:STE 1600
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-4527
Practice Address - Country:US
Practice Address - Phone:602-744-4765
Practice Address - Fax:602-744-4799
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2020-09-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ23976207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00217971OtherMEDICARE RAILROAD
AZ370768Medicaid
AZZ84308Medicare PIN
G33659Medicare UPIN