Provider Demographics
NPI:1265434724
Name:PRINGLE, SCOT G (MD)
Entity type:Individual
Prefix:DR
First Name:SCOT
Middle Name:G
Last Name:PRINGLE
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 1:1111 N MOUNT AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-3437
Mailing Address - Country:US
Mailing Address - Phone:573-339-1101
Mailing Address - Fax:573-339-1737
Practice Address - Street 1:1111 N MOUNT AUBURN RD
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-3437
Practice Address - Country:US
Practice Address - Phone:573-339-1101
Practice Address - Fax:573-339-1737
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4B20207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO289276OtherHEALTHLINK
MO105643OtherBLUE CROSS BLUE SHIELD
MO201527934Medicaid
MO201527934Medicaid
MO289276OtherHEALTHLINK
MO990001451Medicare ID - Type UnspecifiedGROUP MCARE
MO160038853Medicare ID - Type UnspecifiedRAILROAD MCARE