Individual
DANIEL WAYNE INGRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA C
Contact information
Practice address
4207 LAKE BOONE TRL, RALEIGH, NC 27607
(919) 785-3400
Mailing address
4207 LAKE BOONE TRL, RALEIGH, NC 27607-6684
(919) 784-1410
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
102777
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7910885
—
NC
Enumeration date
02/21/2006
Last updated
03/29/2021
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