Healthcare Provider Details

I. General information

NPI: 1528175890
Provider Name (Legal Business Name): ROBERT EDWARD WINANS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1719 E BIJOU ST
COLORADO SPRINGS CO
80909-5736
US

IV. Provider business mailing address

PO BOX 909
COLORADO SPRINGS CO
80901-0909
US

V. Phone/Fax

Practice location:
  • Phone: 719-596-5665
  • Fax:
Mailing address:
  • Phone: 719-576-4171
  • Fax: 719-592-1645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number23377
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: