Individual
BRADFORD INGRAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1800 SAGER RD, ROCKDALE, TX 76567-2060
(512) 689-1364
Mailing address
1800 SAGER RD, ROCKDALE, TX 76567-2060
(512) 689-1364
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
313179
TX
Other
Enumeration date
01/03/2019
Last updated
01/03/2019
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