Provider Demographics
NPI:1083816276
Name:WINNER, BOBBY JOHN (LSA)
Entity type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:JOHN
Last Name:WINNER
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1268
Mailing Address - Street 2:
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634-1268
Mailing Address - Country:US
Mailing Address - Phone:512-769-9529
Mailing Address - Fax:
Practice Address - Street 1:2815 SAINT PAUL RIVERA
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-5708
Practice Address - Country:US
Practice Address - Phone:512-769-9529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist