Healthcare Provider Details

I. General information

NPI: 1710102173
Provider Name (Legal Business Name): MARK S WINDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32940 PERSHING ROAD
COLOMBUS NM
88029
US

IV. Provider business mailing address

PO BOX 601
COLUMBUS NM
88029-0601
US

V. Phone/Fax

Practice location:
  • Phone: 505-531-2591
  • Fax:
Mailing address:
  • Phone: 505-531-2591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number49781
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: