Provider Demographics
NPI:1194756999
Name:WINTERS, JACK CHRISTIAN (MD)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:CHRISTIAN
Last Name:WINTERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1542 TULANE AVE
Mailing Address - Street 2:ROOM 547
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2865
Mailing Address - Country:US
Mailing Address - Phone:504-568-2207
Mailing Address - Fax:504-568-2307
Practice Address - Street 1:4228 HOUMA BLVD
Practice Address - Street 2:SUITE 600A
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-3000
Practice Address - Country:US
Practice Address - Phone:504-412-1600
Practice Address - Fax:504-780-8922
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019976208800000X
LAMD.019976208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1660426Medicaid
LA5W2047627OtherRAILROAD MEDICARE
MS09673036Medicaid
MS09673036Medicaid
LA5W2047627OtherRAILROAD MEDICARE
LA1660426Medicaid