Healthcare Provider Details

I. General information

NPI: 1033266655
Provider Name (Legal Business Name): WILLIAM H WINKLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 09/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 E 5TH ST STE 200
WSAHINGTON MO
63090
US

IV. Provider business mailing address

851 E 5TH ST STE 200
WASHINGTON MO
63090-3135
US

V. Phone/Fax

Practice location:
  • Phone: 636-239-8585
  • Fax: 636-239-8553
Mailing address:
  • Phone: 636-239-8585
  • Fax: 636-239-8553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR7755
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier036069113 2
Identifier TypeMEDICAID
Identifier StateIL
Identifier Issuer
# 2
Identifier34010400
Identifier TypeMEDICAID
Identifier StateWI
Identifier Issuer
# 3
IdentifierP01007128DB7792
Identifier TypeOTHER
Identifier StateWI
Identifier IssuerRR MEDICARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: