Healthcare Provider Details

I. General information

NPI: 1730882069
Provider Name (Legal Business Name): KEVIN RONALD WINDECKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 S CONROE MEDICAL DR
CONROE TX
77304-4722
US

IV. Provider business mailing address

1003 COLLEGE ST
JUNCTION TX
76849-4632
US

V. Phone/Fax

Practice location:
  • Phone: 936-539-4004
  • Fax: 936-521-3964
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberW7160
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: