Healthcare Provider Details

I. General information

NPI: 1972506277
Provider Name (Legal Business Name): KENT D WINKLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date: 03/20/2006
Reactivation Date: 05/09/2006

III. Provider practice location address

2000 S THOMPSON ST
FLAGSTAFF AZ
86001-8759
US

IV. Provider business mailing address

2000 S THOMPSON ST
FLAGSTAFF AZ
86001-8759
US

V. Phone/Fax

Practice location:
  • Phone: 928-226-6400
  • Fax: 928-226-6411
Mailing address:
  • Phone: 928-226-6400
  • Fax: 928-226-6411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number30420
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD2023-0260
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMC-0648
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: