Individual
MR. DEWAYNE OCTAVIAN INGRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2739 WILLOWGATE AVE, ORLANDO, FL 32822-4185
(321) 280-0107
Mailing address
2739 WILLOWGATE AVE, ORLANDO, FL 32822-4185
(321) 280-0107
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
FL
Other
Enumeration date
09/27/2022
Last updated
09/27/2022
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