Provider Demographics
NPI:1881626992
Name:WINTER, JOHN W IV (MD PA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:WINTER
Suffix:IV
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 BRYN MAWR DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-7817
Mailing Address - Country:US
Mailing Address - Phone:214-394-7860
Mailing Address - Fax:214-696-1036
Practice Address - Street 1:2929 BRYN MAWR DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-7817
Practice Address - Country:US
Practice Address - Phone:214-394-7860
Practice Address - Fax:214-696-1036
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2019-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1969208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097319002Medicaid
C23678Medicare UPIN