Basic Information
| Provider Information | |||||||||
| NPI: | 1174508923 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WINNEFELD | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | WILLIAM | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1060 ORCHARD AVE UNIT H | ||||||||
| Address2: | |||||||||
| City: | GRAND JUNCTION | ||||||||
| State: | CO | ||||||||
| PostalCode: | 815012997 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702417600 | ||||||||
| FaxNumber: | 9702459094 | ||||||||
| Practice Location | |||||||||
| Address1: | 1060 ORCHARD AVE UNIT H | ||||||||
| Address2: | |||||||||
| City: | GRAND JUNCTION | ||||||||
| State: | CO | ||||||||
| PostalCode: | 815012997 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702417600 | ||||||||
| FaxNumber: | 9702459094 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2005 | ||||||||
| LastUpdateDate: | 12/12/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 45254 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8239843 | 05 | CO | MEDICAID |