Healthcare Provider Details

I. General information

NPI: 1689652547
Provider Name (Legal Business Name): ROBERT P WINTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2006
Last Update Date: 09/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S MAITLAND AVE
MAITLAND FL
32751-5619
US

IV. Provider business mailing address

400 S MAITLAND AVE
MAITLAND FL
32751-5619
US

V. Phone/Fax

Practice location:
  • Phone: 407-539-2100
  • Fax: 407-539-1472
Mailing address:
  • Phone: 407-539-2100
  • Fax: 407-539-1472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number57851
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: