Organization
INGRAM CO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD ROSS (CEO)
(405) 719-3905
Entity
Organization
Contact information
Practice address
6525 N MERIDIAN AVE, OKLAHOMA CITY, OK 73116-1420
(405) 719-3905
Mailing address
6525 N MERIDIAN AVE, OKLAHOMA CITY, OK 73116-1420
(405) 719-3905
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
8457
OK
Other
Enumeration date
08/15/2012
Last updated
09/18/2012
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