1629067251 NPI number — BRIAN E WINN M.D.

Table of content: BRIAN E WINN M.D. (NPI 1629067251)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629067251 NPI number — BRIAN E WINN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WINN
Provider First Name:
BRIAN
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WINN
Provider Other First Name:
BRIAN
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1629067251
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1303 MCCULLOUGH AVE
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78212-5609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-225-2551
Provider Business Mailing Address Fax Number:
210-225-3896

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1303 MCCULLOUGH AVE
Provider Second Line Business Practice Location Address:
SUITE 600
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78212-5609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-225-2551
Provider Business Practice Location Address Fax Number:
210-225-3896
Provider Enumeration Date:
10/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X , with the licence number:  H5280 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: H5280 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 035668502 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00871878 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 035668501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110109944 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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