Healthcare Provider Details

I. General information

NPI: 1821229709
Provider Name (Legal Business Name): JAMES B WINBLAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W MAPLE ST
FARMINGTON NM
87401-5630
US

IV. Provider business mailing address

PO BOX 2019
FARMINGTON NM
87499-2019
US

V. Phone/Fax

Practice location:
  • Phone: 505-325-1572
  • Fax: 505-327-4887
Mailing address:
  • Phone: 505-325-1572
  • Fax: 505-327-4887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2016007047
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD2020-0269
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number2016007047
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberE-9740
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: