Individual
RUSSELL D. INGRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7530 NW 23RD ST, BETHANY, OK 73008-4921
(405) 787-8550
(405) 787-4982
Mailing address
7530 NW 23RD ST, BETHANY, OK 73008-4921
(405) 787-8550
(405) 787-4982
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
26430
OK
Other
Enumeration date
07/25/2008
Last updated
07/31/2015
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