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General NPI Number Information
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NPI Number | 1245297316
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Entity Type | Individual
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Provider Name | JERALD LUKE WINTER M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/01/2006
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Last Update Date | 08/07/2024
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Provider Practice Location Address
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Address Line | 195 KIMEL PARK DR STE 200
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City | WINSTON SALEM
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State | NC
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Zip | 27103-6967
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Country | US
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Telephone | 336-768-6211
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Fax |
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Provider Business Mailing Address
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Address Line | 513 EAGLES NEST CT
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City | WINSTON-SALEM
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State | NC
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Zip | 27127-6787
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Country | US
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Telephone | 336-784-8285
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 9701660
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License Number State | NC
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