MEDICARE: CLINTON A. WINSLOW MD, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	14840	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063660561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINTON A. WINSLOW MD, INC

Provider Business Mailing Address
First Line	:	1230 WESTCHESTER DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73114-1215
Country	:	US
Telephone Number	:	405-810-9574
Fax Number	:	405-632-6868

Provider Business Practice Location Address
First Line	:	4300 S SHIELDS BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73129-2864
Country	:	US
Telephone Number	:	405-632-6681
Fax Number	:	405-632-6868

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CLINTON A WINSLOW
Credential	:	M.D.
Telephone Number	:	405-632-6681

Provider Enumeration Date	:	09/09/2008
Last Update Date	:	09/09/2008

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