Healthcare Provider Details

I. General information

NPI: 1316943673
Provider Name (Legal Business Name): MARK D. WINTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MARK D. WINTON MD

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 05/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 HIGHLAND BLVD SUITE 4500
BOZEMAN MT
59715
US

IV. Provider business mailing address

905 HIGHLAND BLVD SUITE 4500
BOZEMAN MT
59715-6901
US

V. Phone/Fax

Practice location:
  • Phone: 406-414-5200
  • Fax:
Mailing address:
  • Phone: 406-414-4210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number36530
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number11649
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: