Healthcare Provider Details

I. General information

NPI: 1942450580
Provider Name (Legal Business Name): JONATHAN WINKFIELD PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2008
Last Update Date: 09/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6028 S RIDGELINE DR STE 201
OGDEN UT
84405-6908
US

IV. Provider business mailing address

5896 S RIDGELINE DR STE A
OGDEN UT
84405-4928
US

V. Phone/Fax

Practice location:
  • Phone: 801-475-5400
  • Fax: 801-475-8614
Mailing address:
  • Phone: 801-409-2040
  • Fax: 801-409-0440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7120206-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: