Individual
MR. PHILLIP RANDALL INGRAM
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
9600 VETERANS DR SW, TACOMA, WA 98493-0003
(253) 582-8440
Mailing address
16809 88TH STREET KPS, LONGBRANCH, WA 98351-9521
(253) 884-4315
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA10002587
WA
Other
Enumeration date
04/06/2006
Last updated
07/08/2007
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