Provider Demographics
NPI:1336161264
Name:WINANS, BRUCE DAVID (DPM)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:DAVID
Last Name:WINANS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 MURDOCH AVE
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-4330
Mailing Address - Country:US
Mailing Address - Phone:304-485-3831
Mailing Address - Fax:304-485-3861
Practice Address - Street 1:1033 MURDOCH AVE
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-4330
Practice Address - Country:US
Practice Address - Phone:304-485-3831
Practice Address - Fax:304-485-3861
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00176213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001720261OtherMOUNTAIN STATE BC/BS
OH55062331100OtherWORKERS COMPENSATION
WV0100230000Medicaid
4864260001OtherDMERC
461472OtherANTHEM BC MEDICARE SUPP
6938659002OtherCIGNA INSURANCE
OH0468891Medicaid
T89952Medicare UPIN
461472OtherANTHEM BC MEDICARE SUPP
4864260001OtherDMERC