Provider Demographics
NPI:1295751048
Name:PRINGLE, ROBERT PERRY JR (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PERRY
Last Name:PRINGLE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:110 EXSECUTIVE PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207
Mailing Address - Country:US
Mailing Address - Phone:502-895-4607
Mailing Address - Fax:502-895-4586
Practice Address - Street 1:4001 DUTCHMAN'S LANE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207
Practice Address - Country:US
Practice Address - Phone:502-893-1084
Practice Address - Fax:502-899-6819
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2010-06-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA200202207P00000X
KY40921207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6409744700Medicaid
LA1787183Medicaid
LAH98128Medicare UPIN
H98128Medicare UPIN
LA1787183Medicaid