Basic Information
| Provider Information | |||||||||
| NPI: | 1689739542 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WINTER | ||||||||
| FirstName: | SAMUEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 98978 | ||||||||
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| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891938978 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022163346 | ||||||||
| FaxNumber: | 7026716883 | ||||||||
| Practice Location | |||||||||
| Address1: | 1397 S LOOP RD | ||||||||
| Address2: | |||||||||
| City: | PAHRUMP | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757275500 | ||||||||
| FaxNumber: | 7757275696 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2006 | ||||||||
| LastUpdateDate: | 06/22/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0505X | 1267 | NV | Y | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine |
No ID Information.