Provider Demographics
NPI:1316143886
Name:RINGO, SHELLEY R (MD)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:R
Last Name:RINGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 NE WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99164-2302
Mailing Address - Country:US
Mailing Address - Phone:509-335-3575
Mailing Address - Fax:509-335-6223
Practice Address - Street 1:1125 NE WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99164-2302
Practice Address - Country:US
Practice Address - Phone:509-335-3575
Practice Address - Fax:509-335-6223
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-10668207Q00000X, 207QS0010X
WAMD00046953207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1196090Medicare PIN