Healthcare Provider Details

I. General information

NPI: 1467576330
Provider Name (Legal Business Name): WINSTON WILLIAM THOMAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2007
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 HARBOR BLVD
PORT CHARLOTTE FL
33952-5000
US

IV. Provider business mailing address

22295 MORRIS AVE
PORT CHARLOTTE FL
33952-6955
US

V. Phone/Fax

Practice location:
  • Phone: 941-206-7251
  • Fax:
Mailing address:
  • Phone: 518-335-8303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number4301089360
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number256929
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: