Healthcare Provider Details

I. General information

NPI: 1912988775
Provider Name (Legal Business Name): KEITH A WINDER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3153 E WARM SPRINGS #300
LAS VEGAS NV
89120
US

IV. Provider business mailing address

PO BOX 840857
DALLAS TX
75284-0857
US

V. Phone/Fax

Practice location:
  • Phone: 702-487-6510
  • Fax: 702-405-7960
Mailing address:
  • Phone: 972-715-5000
  • Fax: 972-715-9976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberDO1409
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number1409
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number1409
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: