Provider Demographics
NPI:1992923460
Name:WINKLE, PETER JOHN (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:JOHN
Last Name:WINKLE
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 1:11741 VALLEY VIEW ST
Mailing Address - Street 2:A
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-5500
Mailing Address - Country:US
Mailing Address - Phone:714-897-1071
Mailing Address - Fax:714-897-0125
Practice Address - Street 1:11741 VALLEY VIEW ST
Practice Address - Street 2:A
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-5500
Practice Address - Country:US
Practice Address - Phone:714-897-1071
Practice Address - Fax:714-897-0125
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG70077207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000G70077Medicaid
F23238Medicare UPIN
CA000G70077Medicaid