Healthcare Provider Details

I. General information

NPI: 1255691226
Provider Name (Legal Business Name): ROBERT ALAN WINTER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 05/14/2020
Certification Date: 05/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 E MCKELLIPS RD STE 110
MESA AZ
85203-2766
US

IV. Provider business mailing address

2500 W UTOPIA RD STE 100
PHOENIX AZ
85027-4171
US

V. Phone/Fax

Practice location:
  • Phone: 480-882-7370
  • Fax: 602-547-7301
Mailing address:
  • Phone: 623-434-6200
  • Fax: 623-434-6107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number006533
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: