Basic Information
Provider Information
NPI: 1104891910
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WINTERS
FirstName: GEORGE
MiddleName: R
NamePrefix:  
NameSuffix: III
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 84088
Address2:  
City: SEATTLE
State: WA
PostalCode: 981248488
CountryCode: US
TelephoneNumber: 4254545281
FaxNumber: 4259905261
Practice Location
Address1: 1135 116TH AVE NE
Address2: SUITE 140
City: BELLEVUE
State: WA
PostalCode: 980044623
CountryCode: US
TelephoneNumber: 4254670150
FaxNumber: 4259905261
Other Information
ProviderEnumerationDate: 02/23/2006
LastUpdateDate: 11/03/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RG0100XMD00045792WAY Allopathic & Osteopathic PhysiciansInternal MedicineGastroenterology

No ID Information.


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