Healthcare Provider Details

I. General information

NPI: 1063631661
Provider Name (Legal Business Name): CHRISTOPHER L. WINSLOW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 04/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 S BAKER ST
MOUNTAIN HOME AR
72653-4711
US

IV. Provider business mailing address

PO BOX 10050
FAYETTEVILLE AR
72703-0036
US

V. Phone/Fax

Practice location:
  • Phone: 870-508-2646
  • Fax: 870-508-2644
Mailing address:
  • Phone: 870-424-5079
  • Fax: 870-424-8455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License NumberE 4224
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: