Healthcare Provider Details

I. General information

NPI: 1184625139
Provider Name (Legal Business Name): GEORGE EDWARD WINDSOR DO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 N MAIN ST
WINDSOR MO
65360
US

IV. Provider business mailing address

PO BOX 107
WINDSOR MO
65360
US

V. Phone/Fax

Practice location:
  • Phone: 660-647-2111
  • Fax: 660-647-2110
Mailing address:
  • Phone: 660-647-2111
  • Fax: 660-647-2110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number32300
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: