Provider Demographics
NPI:1528049889
Name:RINGHOFER, ROBERT BRAD (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:BRAD
Last Name:RINGHOFER
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 23340
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63156-3340
Mailing Address - Country:US
Mailing Address - Phone:618-277-7500
Mailing Address - Fax:618-277-4236
Practice Address - Street 1:611 S MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:MC LEANSBORO
Practice Address - State:IL
Practice Address - Zip Code:62859-1213
Practice Address - Country:US
Practice Address - Phone:618-643-2361
Practice Address - Fax:618-643-2502
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036063325207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2616OtherBCBS TRI ST
ILC45531OtherMERCY
IL000000010032OtherESSENCE
IL036063325Medicaid
IL5950091OtherAETNA
IL08221955OtherBCBS
IL123506OtherHEALTHLINK
IL127487OtherGHP
IL0407154OtherUHC
IL036063325Medicaid
IL5950091OtherAETNA
ILC45531Medicare UPIN