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NPI Code Detail

MEDICARE: BERRY E WINN MD PLLC

MEDICARE: BERRY E WINN MD PLLC
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
1207PE0004XEmergency Medical Services (Emergency Medicine) PhysicianOK

Other Identifiers

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

General Provider Information

NPI Number : 1811987761
Entity Type Code : Organization
Provider Name (Legal Business Name) : BERRY E WINN MD PLLC
Provider Business Mailing Address
First Line : LOCKBOX #17
Second Line : 2424 E. 21ST #100
City : TULSA
State : OK
Zip : 74114-1711
Country : US
Telephone Number : 866-321-8433
Fax Number :
Provider Business Practice Location Address
First Line : 300 ROCKEFELLER DR
Second Line :
City : MUSKOGEE
State : OK
Zip : 74401-5075
Country : US
Telephone Number : 918-781-9466
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : BERRY E WINN
Credential : M.D.
Telephone Number : 918-781-9466
Provider Enumeration Date : 10/24/2005
Last Update Date : 10/02/2013

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