Provider Demographics
NPI:1912911686
Name:WINTER, TREVOR ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:ANTHONY
Last Name:WINTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 CORONADO AVE
Mailing Address - Street 2:
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-5109
Mailing Address - Country:US
Mailing Address - Phone:859-492-2931
Mailing Address - Fax:
Practice Address - Street 1:3700 MALL VIEW RD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-3050
Practice Address - Country:US
Practice Address - Phone:859-492-2931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYFL010207R00000X, 207RG0100X
CAC53974207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64075526Medicaid
KY64075526Medicaid
0741033Medicare ID - Type Unspecified