MEDICARE: DR. MARK L. WINTER 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	207Y00000X	Otolaryngology Physician	E9027	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	040009551	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4547130	OTHER	TX	AETNA INSURANCE
2	127130100	OTHER	TX	FIRST CARE INSURANCE
3	00PC04	OTHER		BLUE CROSS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740283571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK L. WINTER M.D.

Provider Business Mailing Address
First Line	:	4432 S LOOP 289
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79414-5005
Country	:	US
Telephone Number	:	806-793-0845
Fax Number	:	806-799-3987

Provider Business Practice Location Address
First Line	:	4432 S LOOP 289
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79414-5005
Country	:	US
Telephone Number	:	806-793-0845
Fax Number	:	806-799-3987

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	08/14/2008

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Directions to “ DR. MARK L. WINTER M.D.” Practice Location

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