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Individual

KIRK EDWARD WINWARD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
5169 COTTONWOOD ST STE 630, SALT LAKE CITY, UT 84107-6771
(801) 281-3030
(801) 281-3033
Mailing address
5169 COTTONWOOD ST STE 630, SALT LAKE CITY, UT 84107-6771
(801) 281-3030
(801) 281-3033

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
187019 1205
UT
207W00000X
Ophthalmology Physician
187019-1205
UT
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
187019-1205
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010486
MEDICARE
01
00341000
MEDICAID
ID
01
005545102
MEDICARE
01
005545202
MEDICARE
01
005584702
MEDICARE
01
104743400
MEDICAID
WY
01
180013350
RAILROAD MEDICARE
01
870525682
TAX ID #
Enumeration date
12/14/2005
Last updated
02/05/2018
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