Healthcare Provider Details

I. General information

NPI: 1215985692
Provider Name (Legal Business Name): VINCENT J VANWINKLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: VINCENT J VAN WINKLE M.D.

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 10/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 BEE RIDGE RD SUITE E BLDG E
SARASOTA FL
34233
US

IV. Provider business mailing address

3920 BEE RIDGE RD SUITE E BLDG E
SARASOTA FL
34233
US

V. Phone/Fax

Practice location:
  • Phone: 941-923-1861
  • Fax: 941-927-8491
Mailing address:
  • Phone: 941-923-1861
  • Fax: 941-927-8491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME44850
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: