Provider Demographics
NPI:1366434300
Name:KIPGEN, WYNTER WILLIAMS (MD)
Entity type:Individual
Prefix:
First Name:WYNTER
Middle Name:WILLIAMS
Last Name:KIPGEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 W FARM RD
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74078-4226
Mailing Address - Country:US
Mailing Address - Phone:405-744-7665
Mailing Address - Fax:405-744-2059
Practice Address - Street 1:1202 W FARM RD
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74078-4226
Practice Address - Country:US
Practice Address - Phone:405-744-7665
Practice Address - Fax:405-744-2059
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18443207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
F70357Medicare UPIN
F70357Medicare UPIN