Provider Demographics
NPI:1043375819
Name:RIEHL, WINSTON (MD)
Entity type:Individual
Prefix:
First Name:WINSTON
Middle Name:
Last Name:RIEHL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51775
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-1775
Mailing Address - Country:US
Mailing Address - Phone:337-234-9925
Mailing Address - Fax:337-235-3357
Practice Address - Street 1:6011 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:LA
Practice Address - Zip Code:70592-5170
Practice Address - Country:US
Practice Address - Phone:337-234-9925
Practice Address - Fax:337-235-3357
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA008272207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA52752Medicare ID - Type Unspecified