Provider Demographics
NPI:1043495088
Name:TIMOTHY C PRINGLE MD PA
Entity type:Organization
Organization Name:TIMOTHY C PRINGLE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:C
Authorized Official - Last Name:PRINGLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-906-0011
Mailing Address - Street 1:560 W MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-3629
Mailing Address - Country:US
Mailing Address - Phone:972-906-0011
Mailing Address - Fax:972-906-0815
Practice Address - Street 1:560 W MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3629
Practice Address - Country:US
Practice Address - Phone:972-906-0011
Practice Address - Fax:972-906-0815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX999992086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXA0155706OtherDPS REGISTRATION