Individual
BRIAN R INGRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1851 OLD HWY 66, EDGEWOOD, NM 87015
(505) 286-2396
(505) 286-2398
Mailing address
12127B HWY 14 N STE 5, CEDAR CREST, NM 87008-9499
(505) 281-5180
(505) 281-5320
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2018-0050
NM
Other
Enumeration date
08/30/2018
Last updated
08/30/2018
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