Healthcare Provider Details

I. General information

NPI: 1144372632
Provider Name (Legal Business Name): BEN M WINKES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N LAVENTURE RD
MOUNT VERNON WA
98273-2766
US

IV. Provider business mailing address

PO BOX 34703
SEATTLE WA
98124-1703
US

V. Phone/Fax

Practice location:
  • Phone: 360-542-8900
  • Fax: 360-542-8796
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00039714
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: