MEDICARE: DR. MARK R. WINKLER MD

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	207R00000X	Internal Medicine Physician	G067756	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G067756	OTHER	CA	CA LICENSE

General Provider Information

NPI Number	:	1871568659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK R. WINKLER MD

Provider Business Mailing Address
First Line	:	PO BOX 941317
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93094-1317
Country	:	US
Telephone Number	:	818-882-5375
Fax Number	:	818-882-6063

Provider Business Practice Location Address
First Line	:	14366 SHAWNEE ST
Second Line	:
City	:	MOORPARK
State	:	CA
Zip	:	93021-3569
Country	:	US
Telephone Number	:	818-882-5375
Fax Number	:	818-882-6063

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

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	04/12/2017

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