Individual
COBURN G. INGRAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
52 ENGH RD UNIT 30, OMAK, WA 98841-9646
(509) 429-0949
Mailing address
52 ENGH RD UNIT 30, OMAK, WA 98841-9646
(509) 429-0949
Taxonomy
Speciality
Code
Description
License number
State
171R00000X
Interpreter
Primary
MC12530
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0303065
L&I PROVIDER NUMBER
WA
Enumeration date
08/18/2020
Last updated
08/18/2020
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