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General NPI Number Information
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NPI Number | 1851517999
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Entity Type | Individual
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Provider Name | JERRELL INGALLS MD
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Gender | Male
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 07/05/2024
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Provider Practice Location Address
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Address Line | 445 HARLOW RD STE 200
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City | SPRINGFIELD
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State | OR
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Zip | 97477-1341
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Country | US
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Telephone | 541-302-7771
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Fax |
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Provider Business Mailing Address
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Address Line | 445 HARLOW RD STE 200
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City | SPRINGFIELD
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State | OR
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Zip | 97477-1341
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Country | US
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Telephone | 541-302-7771
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 4301083659
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 35.093043
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 43663
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License Number State | KY
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Taxonomy #4
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD60547691
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License Number State | WA
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Taxonomy #5
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 13857
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License Number State | NV
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