Basic Information
| Provider Information | |||||||||
| NPI: | 1154864379 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RICHARD INGLE MD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 292 | ||||||||
| Address2: | |||||||||
| City: | MOUNT SHASTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960670292 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5309267131 | ||||||||
| FaxNumber: | 5309267134 | ||||||||
| Practice Location | |||||||||
| Address1: | 914 PINE ST | ||||||||
| Address2: | |||||||||
| City: | MOUNT SHASTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960672143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7753047237 | ||||||||
| FaxNumber: | 5309267134 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2016 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | INGLE | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | MORIS | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7753047237 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | G59041 | CA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207VX0000X | G59041 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics |
No ID Information.