Provider Demographics
NPI:1447440086
Name:INGRAM, FREDDIE EARL SR
Entity type:Individual
Prefix:MR
First Name:FREDDIE
Middle Name:EARL
Last Name:INGRAM
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14201 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4506
Mailing Address - Country:US
Mailing Address - Phone:501-412-4601
Mailing Address - Fax:
Practice Address - Street 1:14201 RIDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-4506
Practice Address - Country:US
Practice Address - Phone:501-412-4601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies