Provider Demographics
NPI:1053541946
Name:WINSLOW, STEPHEN JAMES JR (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JAMES
Last Name:WINSLOW
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14410 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3237
Mailing Address - Country:US
Mailing Address - Phone:772-589-8111
Mailing Address - Fax:772-589-7561
Practice Address - Street 1:14410 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3237
Practice Address - Country:US
Practice Address - Phone:772-589-8111
Practice Address - Fax:772-589-7561
Is Sole Proprietor?:No
Enumeration Date:2009-07-25
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX539231207R00000X
FLME115563207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
12534140OtherCAQH
FL4185796OtherCIGNA
FL14PW6OtherBCBS
FL088554-00Medicaid
FL5541791OtherAETNA
FL5541791OtherAETNA
FL088554-00Medicaid
FLHJ176WMedicare PIN