MEDICARE: DR. KEITH E INGRAM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	ME46955	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00614586	OTHER		MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	08630	OTHER	FL	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740235878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEITH E INGRAM M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1106
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34995-1106
Country	:	US
Telephone Number	:	772-219-9005
Fax Number	:

Provider Business Practice Location Address
First Line	:	6830 S US HIGHWAY 1
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-1410
Country	:	US
Telephone Number	:	772-873-6700
Fax Number	:	772-465-5499

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	08/20/2013

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Directions to “ DR. KEITH E INGRAM M.D.” Practice Location

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