MEDICARE: DR. WAYNE W INGRAM MD

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	207VG0400X	Gynecology Physician	E7995	TX
2	208600000X	Surgery Physician	E7795	TX

General Provider Information

NPI Number	:	1134120702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WAYNE W INGRAM MD

Provider Business Mailing Address
First Line	:	711 W 38TH ST
Second Line	:	STE G4
City	:	AUSTIN
State	:	TX
Zip	:	78705-1121
Country	:	US
Telephone Number	:	512-458-1208
Fax Number	:	512-458-1409

Provider Business Practice Location Address
First Line	:	711 W 38TH ST
Second Line	:	STE G4
City	:	AUSTIN
State	:	TX
Zip	:	78705-1121
Country	:	US
Telephone Number	:	512-458-1208
Fax Number	:	512-458-1409

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	09/11/2025

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