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General NPI Number Information
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NPI Number | 1811987761
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Entity Type | Organization
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Legal Business Name | BERRY E WINN MD PLLC
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Dates
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Enumeration Date | 10/24/2005
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Last Update Date | 10/02/2013
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Provider Practice Location Address
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Address Line | 300 ROCKEFELLER DR
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City | MUSKOGEE
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State | OK
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Zip | 74401-5075
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Country | US
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Telephone | 918-781-9466
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Fax |
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Provider Business Mailing Address
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Address Line | LOCKBOX #17 2424 E. 21ST #100
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City | TULSA
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State | OK
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Zip | 74114-1711
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Country | US
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Telephone | 866-321-8433
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BERRY E WINN
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Credential | M.D.
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Telephone | 918-781-9466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number |
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License Number State | OK
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