Provider Demographics
NPI:1740283571
Name:WINTER, MARK L (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:L
Last Name:WINTER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4432 S LOOP 289
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79414-5005
Mailing Address - Country:US
Mailing Address - Phone:806-793-0845
Mailing Address - Fax:806-799-3987
Practice Address - Street 1:4432 S LOOP 289
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-5005
Practice Address - Country:US
Practice Address - Phone:806-793-0845
Practice Address - Fax:806-799-3987
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2008-08-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXE9027207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4547130OtherAETNA INSURANCE
TX127130100OtherFIRST CARE INSURANCE
00PC04OtherBLUE CROSS
TX120346502Medicaid
040009551OtherRR MEDICARE
TX120346502OtherFIRST CARE MEDICAID
00PC04OtherBLUE CROSS
TX4547130OtherAETNA INSURANCE