Individual
TIN T WIN
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2180 MCCULLOCH BLVD N, LAKE HAVASU CITY, AZ 86403-6879
(928) 680-8282
(928) 680-8288
Mailing address
PO BOX 1440, LAKE HAVASU CITY, AZ 86405-1440
(928) 680-8282
(928) 680-8288
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
28212
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
AZ77790
—
AZ
Enumeration date
12/19/2005
Last updated
07/08/2007
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