Individual
KENNETH DALE INGRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, L-461, PORTLAND, OR 97239-3011
(503) 494-8577
Mailing address
3181 SW SAM JACKSON PARK RD, 3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00660
OR
Other
Enumeration date
08/01/2006
Last updated
07/10/2007
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