MEDICARE: DR. WINSTON E EVALLE M.D.

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	ME80483	FL
2	207R00000X	Internal Medicine Physician	ME80483	FL
3	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	ME80483	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00061439	OTHER	FL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	58634	OTHER	FL	BC/BS

General Provider Information

NPI Number	:	1265444202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WINSTON E EVALLE M.D.

Provider Business Mailing Address
First Line	:	3351 WEDGEWOOD LN
Second Line	:
City	:	THE VILLAGES
State	:	FL
Zip	:	32162-7181
Country	:	US
Telephone Number	:	352-259-0364
Fax Number	:	352-259-2174

Provider Business Practice Location Address
First Line	:	3351 WEDGEWOOD LN
Second Line	:
City	:	THE VILLAGES
State	:	FL
Zip	:	32162-7181
Country	:	US
Telephone Number	:	352-259-0364
Fax Number	:	352-259-2174

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	12/13/2013

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Directions to “ DR. WINSTON E EVALLE M.D.” Practice Location

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