Provider Demographics
NPI:1316934227
Name:INGLE, GREGORY LEE (DO)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:LEE
Last Name:INGLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E. JEFFERSON STREET
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50228-0430
Mailing Address - Country:US
Mailing Address - Phone:515-994-2617
Mailing Address - Fax:515-994-2365
Practice Address - Street 1:100 E. JEFFERSON ST.
Practice Address - Street 2:
Practice Address - City:PRAIRIE CITY
Practice Address - State:IA
Practice Address - Zip Code:50228-0430
Practice Address - Country:US
Practice Address - Phone:515-994-2617
Practice Address - Fax:515-994-2365
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01695207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA560910082OtherMEDICARE PTAN #
IA01695OtherIOWA LICENSE
IA5151324Medicaid
IA5151324Medicaid
IAI9257Medicare ID - Type Unspecified