Healthcare Provider Details

I. General information

NPI: 1528049889
Provider Name (Legal Business Name): ROBERT BRAD RINGHOFER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 S MARSHALL AVE
MC LEANSBORO IL
62859-1213
US

IV. Provider business mailing address

PO BOX 23340
SAINT LOUIS MO
63156-3340
US

V. Phone/Fax

Practice location:
  • Phone: 618-643-2361
  • Fax: 618-643-2502
Mailing address:
  • Phone: 618-277-7500
  • Fax: 618-277-4236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036063325
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: