Healthcare Provider Details

I. General information

NPI: 1265093900
Provider Name (Legal Business Name): COTY WINN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MINOT AFB MEDICAL GROUP 194 MISSILE AVENUE
MINOT AFB ND
58705
US

IV. Provider business mailing address

MINOT AFB MEDICAL GROUP 194 MISSILE AVENUE
MINOT AFB ND
58705
US

V. Phone/Fax

Practice location:
  • Phone: 701-723-5206
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number0101270418
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: