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Individual
DR. FRED M INGRAM
Active
Individual
DR. FRED M INGRAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2098
OK
207Q00000X
Family Medicine Physician
J7525
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080114575
PALMETTO GBA-RAILROAD
OK
05
—
100106080B
—
OK
01
—
731479823
TRICARE
OK
01
—
731479823001
PGBA(TRICARE SOUTH)
OK
Enumeration date
11/14/2005
Last updated
01/23/2010
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