Provider Demographics
NPI:1487869566
Name:WINSLOW, DWIGHT WALTER (MD)
Entity type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:WALTER
Last Name:WINSLOW
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 1:205 KNUTSEN LN
Mailing Address - Street 2:
Mailing Address - City:SMITH RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95567-9357
Mailing Address - Country:US
Mailing Address - Phone:707-487-9100
Mailing Address - Fax:
Practice Address - Street 1:205 KNUTSEN LN
Practice Address - Street 2:
Practice Address - City:SMITH RIVER
Practice Address - State:CA
Practice Address - Zip Code:95567-9357
Practice Address - Country:US
Practice Address - Phone:707-487-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66017207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine