Basic Information
| Provider Information | |||||||||
| NPI: | 1982975512 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WINOKUR | ||||||||
| FirstName: | MORGAN | ||||||||
| MiddleName: | RAQUEL | ||||||||
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| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 N FEDERAL HWY | ||||||||
| Address2: | #354 | ||||||||
| City: | HALLANDALE BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330092400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004880279 | ||||||||
| FaxNumber: | 8669028817 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 N FEDERAL HWY | ||||||||
| Address2: | #354 | ||||||||
| City: | HALLANDALE BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330092400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004880279 | ||||||||
| FaxNumber: | 8669028817 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2012 | ||||||||
| LastUpdateDate: | 04/25/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 4947 | AZ | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 363AS0400X | 9107851 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 672044 | 05 | AZ | MEDICAID |