Individual
ELLIS A INGRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
ONE HOSPITAL DR, COLUMBIA, MO 65212-0001
(573) 882-1319
(573) 884-4612
Mailing address
PO BOX 7687, COLUMBIA, MO 65205-7687
(573) 882-2259
Taxonomy
Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
R6258
MO
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
R6258
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104034
UNITED HEALHCARE
MO
01
—
126604
HEALTHLINK
MO
01
—
127403
BLUE SHIELD/BLUE CROSS
MO
Enumeration date
06/01/2006
Last updated
02/20/2008
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