Organization
J KEVIN INGRAM MEDICAL, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNNY KEVIN INGRAM MD (OWNER)
(318) 336-8166
Entity
Organization
Contact information
Practice address
1806 CARTER ST, VIDALIA, LA 71373-3115
(318) 757-6526
Mailing address
PO BOX 14149, BATON ROUGE, LA 70898-4149
(888) 924-9827
(225) 924-9829
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD200671
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1066435
—
LA
Enumeration date
02/14/2008
Last updated
06/12/2008
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