Healthcare Provider Details

I. General information

NPI: 1508848201
Provider Name (Legal Business Name): KEVIN L. WINSLOW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 PRUDENTIAL DR SUITE 902
JACKSONVILLE FL
32207-8334
US

IV. Provider business mailing address

836 PRUDENTIAL DR SUITE 902
JACKSONVILLE FL
32207-8334
US

V. Phone/Fax

Practice location:
  • Phone: 904-399-5620
  • Fax: 904-399-8816
Mailing address:
  • Phone: 904-399-5620
  • Fax: 904-399-8816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number47697
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number048401
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: