Provider Demographics
NPI:1194870030
Name:TERRELL P WINKLER MD PA
Entity type:Organization
Organization Name:TERRELL P WINKLER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRELL
Authorized Official - Middle Name:P
Authorized Official - Last Name:WINKLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-491-5511
Mailing Address - Street 1:4001 NORTH OCEAN DRIVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-5968
Mailing Address - Country:US
Mailing Address - Phone:954-491-5511
Mailing Address - Fax:
Practice Address - Street 1:4001 NORTH OCEAN DRIVE
Practice Address - Street 2:SUITE 203
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-5968
Practice Address - Country:US
Practice Address - Phone:954-491-5511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL08930Medicare ID - Type Unspecified