Basic Information
Provider Information
NPI: 1568479038
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WINEBURGH
FirstName: GEORGE
MiddleName: SAMUEL
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9960 CENTRAL PARK BLVD N
Address2: SUITE 450
City: BOCA RATON
State: FL
PostalCode: 334281759
CountryCode: US
TelephoneNumber: 5613531225
FaxNumber: 5613531226
Practice Location
Address1: 3918 VIA POINCIANA
Address2: SUITE 5
City: LAKE WORTH
State: FL
PostalCode: 334672991
CountryCode: US
TelephoneNumber: 5614342238
FaxNumber: 5614342813
Other Information
ProviderEnumerationDate: 08/01/2006
LastUpdateDate: 05/13/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RR0500XME89924FLY Allopathic & Osteopathic PhysiciansInternal MedicineRheumatology

No ID Information.


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