Individual
MR. ANTHONY INGRAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
20779 E 48TH ST S, BROKEN ARROW, OK 74014-8756
(918) 271-0586
Mailing address
20779 E 48TH ST S, BROKEN ARROW, OK 74014-8756
(918) 271-0586
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
01/12/2016
Last updated
01/12/2016
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