Provider Demographics
NPI:1336270347
Name:WINCZURA, JOHN ANDREW (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ANDREW
Last Name:WINCZURA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1444 S CREEK RD
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-9461
Mailing Address - Country:US
Mailing Address - Phone:907-622-4663
Mailing Address - Fax:907-622-4643
Practice Address - Street 1:1444 S CREEK RD
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-9461
Practice Address - Country:US
Practice Address - Phone:907-622-4663
Practice Address - Fax:907-622-4643
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKPAD 441363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMDA0160Medicaid
AKK161600Medicare PIN