Provider Demographics
NPI:1447366711
Name:INGRAM, JOHN E (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:INGRAM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2888 LONG BEACH BLVD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1530
Mailing Address - Country:US
Mailing Address - Phone:562-595-6891
Mailing Address - Fax:562-490-7271
Practice Address - Street 1:2888 LONG BEACH BLVD
Practice Address - Street 2:SUITE 340
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1530
Practice Address - Country:US
Practice Address - Phone:562-595-6891
Practice Address - Fax:562-490-7271
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2012-03-08
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Provider Licenses
StateLicense IDTaxonomies
CAG24803208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ75909ZMedicaid
CAZZZ75909ZMedicaid
CAA42396Medicare UPIN