Brian R Ingram, PA

NPI #1700368495 in Edgewood, New Mexico

Provider Information

NPI Number: 1700368495
Entity Type: Individual
Name: Brian R Ingram, PA
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PA
Enumeration Date: Aug 30, 2018
Last Updated: Aug 30, 2018

Practice Location

Address: 1851 OLD HWY 66
City: Edgewood
State: New Mexico
ZIP Code: 87015
Phone: (505) 286-2396

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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