Provider Demographics
NPI:1770739260
Name:IRVING, WINSTON DACOSTA (MD)
Entity type:Individual
Prefix:DR
First Name:WINSTON
Middle Name:DACOSTA
Last Name:IRVING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1244 WALDEN DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-8834
Mailing Address - Country:US
Mailing Address - Phone:646-725-2800
Mailing Address - Fax:866-908-1231
Practice Address - Street 1:1244 WALDEN DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901
Practice Address - Country:US
Practice Address - Phone:646-725-2800
Practice Address - Fax:866-908-1231
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20120111452085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology