Basic Information
| Provider Information | |||||||||
| NPI: | 1952563280 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WINSTON | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | PHILLIP | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41627 N BENT CREEK CT | ||||||||
| Address2: | |||||||||
| City: | ANTHEM | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850861903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2022130463 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4055 VALLEY VIEW LN | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752445074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727153800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2008 | ||||||||
| LastUpdateDate: | 10/10/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | DOS-1417 | HI | N | Allopathic & Osteopathic Physicians | General Practice | 208D00000X | 7805 | AZ | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.