Provider Demographics
NPI:1366838211
Name:INGLE, MATTHEW LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:LAWRENCE
Last Name:INGLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 768
Mailing Address - Street 2:
Mailing Address - City:PLAINS
Mailing Address - State:MT
Mailing Address - Zip Code:59859-0768
Mailing Address - Country:US
Mailing Address - Phone:541-824-1225
Mailing Address - Fax:406-826-4811
Practice Address - Street 1:10 KRUGER RD
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:MT
Practice Address - Zip Code:59859-0768
Practice Address - Country:US
Practice Address - Phone:775-682-8625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD189233207P00000X
MT112737207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine