Individual
DR. WINSLO K IDICULA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3601 4TH STREET STOP 9905, LUBBOCK, TX 79430-3153
(806) 743-3277
Mailing address
4007 127TH ST, LUBBOCK, TX 79423
(214) 680-9624
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
57017666
OH
207YP0228X
Pediatric Otolaryngology Physician
Primary
R0023
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
CO
Other
Enumeration date
07/22/2010
Last updated
03/26/2021
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