Healthcare Provider Details

I. General information

NPI: 1932303997
Provider Name (Legal Business Name): ROBERT EDWARD WINANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17585 CHIPPED ARROW WAY
MONUMENT CO
80132-8514
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:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number23377
License Number StateCO

VIII. Authorized Official

Name: DR. ROBERT EDWARD WINANS
Title or Position: OWNER
Credential: DO
Phone: 719-576-4171