Healthcare Provider Details

I. General information

NPI: 1124015037
Provider Name (Legal Business Name): GREGORY L. INGLE, D.O., P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E JEFFERSON ST.
PRAIRIE CITY IA
50228
US

IV. Provider business mailing address

PO BOX 430
PRAIRIE CITY IA
50228-0430
US

V. Phone/Fax

Practice location:
  • Phone: 515-994-2617
  • Fax: 515-994-2365
Mailing address:
  • Phone: 515-994-2617
  • Fax: 515-994-2365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GREGORY LEE INGLE
Title or Position: PRESIDENT
Credential: D.O.
Phone: 515-994-2617