Provider Demographics
NPI:1669961835
Name:WINTER, STEPHEN PATRICK (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:PATRICK
Last Name:WINTER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:877 W MAIN ST STE 603
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6070
Mailing Address - Country:US
Mailing Address - Phone:208-954-8070
Mailing Address - Fax:208-954-8073
Practice Address - Street 1:1055 N CURTIS RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1309
Practice Address - Country:US
Practice Address - Phone:208-367-2121
Practice Address - Fax:706-596-6720
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2024-08-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT11414344-12052085R0202X
MI43015095382085R0202X
ORMD2196312085R0202X
IDM-178302085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology