Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 01075633A | IN |
Y | 207Q00000X | Family Doctor | 33564 | SC |
N | 207QS0010X | Family Doctor - Sports Medicine | 01075633A | IN |
NPI | 1336433010 |
---|---|
Provider Name | Jacob Matthew Ringenberg |
First Address | Vincennes, IN 47591-1340 |
Second Address | Greenwood, SC 29646-3869 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2011 |
Last Update Date | 15/10/2019 |