Provider Demographics
NPI:1902855539
Name:NAGLE, ERIC A (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:A
Last Name:NAGLE
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 1:4695 SHORELINE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55384-9715
Mailing Address - Country:US
Mailing Address - Phone:952-442-7890
Mailing Address - Fax:952-442-7894
Practice Address - Street 1:4695 SHORELINE DR
Practice Address - Street 2:
Practice Address - City:SPRING PARK
Practice Address - State:MN
Practice Address - Zip Code:55384-9715
Practice Address - Country:US
Practice Address - Phone:952-442-7890
Practice Address - Fax:952-442-7894
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34356207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN187578700Medicaid
MN187578700Medicaid