MEDICARE: GREGORY LEE INGLE D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	01695	IA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	560910082	OTHER	IA	MEDICARE PTAN #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	01695	OTHER	IA	IOWA LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316934227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY LEE INGLE D.O.

Provider Business Mailing Address
First Line	:	100 E. JEFFERSON STREET
Second Line	:
City	:	PRAIRIE CITY
State	:	IA
Zip	:	50228-0430
Country	:	US
Telephone Number	:	515-994-2617
Fax Number	:	515-994-2365

Provider Business Practice Location Address
First Line	:	100 E. JEFFERSON ST.
Second Line	:
City	:	PRAIRIE CITY
State	:	IA
Zip	:	50228-0430
Country	:	US
Telephone Number	:	515-994-2617
Fax Number	:	515-994-2365

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	07/21/2022

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Directions to “ GREGORY LEE INGLE D.O.” Practice Location

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