Individual
DR. FRED M INGRAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1205 W MAIN ST, COLLINSVILLE, OK 74021-3114
(918) 371-5885
(918) 371-5986
Mailing address
1205 W MAIN ST, COLLINSVILLE, OK 74021-3114
(918) 371-5885
(918) 371-5986
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2098
OK
207Q00000X
Family Medicine Physician
J7525
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080114575
PALMETTO GBA-RAILROAD
OK
05
—
100106080B
—
OK
01
—
731479823
TRICARE
OK
01
—
731479823001
PGBA(TRICARE SOUTH)
OK
Enumeration date
11/14/2005
Last updated
01/23/2010
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