Provider Demographics
NPI:1962278879
Name:OVERTON, JOHN WINSTON JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WINSTON
Last Name:OVERTON
Suffix:JR
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 1:3985 PLYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-5003
Mailing Address - Country:US
Mailing Address - Phone:612-709-4417
Mailing Address - Fax:
Practice Address - Street 1:3985 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-5003
Practice Address - Country:US
Practice Address - Phone:612-709-4417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN30292207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine