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NPI Code Detail

MEDICARE: DR. FRED M INGRAM D.O.

MEDICARE: DR. FRED M INGRAM D.O.
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
1207Q00000XFamily Medicine Physician2098OK
2207Q00000XFamily Medicine PhysicianJ7525TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1080114575OTHEROKPALMETTO GBA-RAILROAD
2731479823001OTHEROKPGBA(TRICARE SOUTH)
3731479823OTHEROKTRICARE
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1699756957
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. FRED M INGRAM D.O.
Provider Business Mailing Address
First Line : 1205 W MAIN ST
Second Line :
City : COLLINSVILLE
State : OK
Zip : 74021-3114
Country : US
Telephone Number : 918-371-5885
Fax Number : 918-371-5986
Provider Business Practice Location Address
First Line : 1205 W MAIN ST
Second Line :
City : COLLINSVILLE
State : OK
Zip : 74021-3114
Country : US
Telephone Number : 918-371-5885
Fax Number : 918-371-5986
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2005
Last Update Date : 01/23/2010

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Directions to “ DR. FRED M INGRAM D.O.” Practice Location

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