Healthcare Provider Details

I. General information

NPI: 1821588161
Provider Name (Legal Business Name): JAN PIETER TE WINKEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2018
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2270 S RIDGEVIEW DR STE 201
YUMA AZ
85364-8880
US

IV. Provider business mailing address

2400 S AVENUE A
YUMA AZ
85364-7170
US

V. Phone/Fax

Practice location:
  • Phone: 928-344-5055
  • Fax:
Mailing address:
  • Phone: 928-344-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number69994
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: