Provider Demographics
NPI:1215985692
Name:VANWINKLE, VINCENT J (MD)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:J
Last Name:VANWINKLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:VINCENT
Other - Middle Name:J
Other - Last Name:VAN WINKLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3920 BEE RIDGE RD
Mailing Address - Street 2:SUITE E BLDG E
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233
Mailing Address - Country:US
Mailing Address - Phone:941-923-1861
Mailing Address - Fax:941-927-8491
Practice Address - Street 1:3920 BEE RIDGE RD
Practice Address - Street 2:SUITE E BLDG E
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233
Practice Address - Country:US
Practice Address - Phone:941-923-1861
Practice Address - Fax:941-927-8491
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44850208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL58437OtherBCBS
FL001943228003OtherUNITED HEALTHCARE
FL3275780OtherAETNA
FL6044269OtherCIGNA
FLP00036287OtherRAILROAD MEDICARE
FL001943228003OtherUNITED HEALTHCARE
FLD56968Medicare PIN