Healthcare Provider Details

I. General information

NPI: 1174889885
Provider Name (Legal Business Name): JOSEPH MATTHEW INGRAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2012
Last Update Date: 05/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 GADSDEN HWY
BIRMINGHAM AL
35235
US

IV. Provider business mailing address

1801 GADSDEN HWY
BIRMINGHAM AL
35235-3134
US

V. Phone/Fax

Practice location:
  • Phone: 205-838-3900
  • Fax: 205-838-3906
Mailing address:
  • Phone: 205-838-3900
  • Fax: 205-838-3906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD.33079
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number55669
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25156
License Number StateMS
# 4
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberMD.33079
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: