Individual
DR. KEITH E INGRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6830 S US HIGHWAY 1, PORT ST LUCIE, FL 34952-1410
(772) 873-6700
(772) 465-5499
Mailing address
PO BOX 1106, STUART, FL 34995-1106
(772) 219-9005
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
ME46955
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007276900
—
FL
01
—
08630
BLUE CROSS BLUE SHIELD
FL
01
—
P00614586
MEDICARE RAILROAD
—
Enumeration date
05/24/2006
Last updated
08/20/2013
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