Provider Demographics
NPI:1093707176
Name:INGRAM, JIM MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:JIM
Middle Name:MARK
Last Name:INGRAM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:18 CORPORATE HILL DRIVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4565
Mailing Address - Country:US
Mailing Address - Phone:501-224-1156
Mailing Address - Fax:501-801-5561
Practice Address - Street 1:18 CORPORATE HILL DR
Practice Address - Street 2:SUITE 110
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-4565
Practice Address - Country:US
Practice Address - Phone:501-224-1156
Practice Address - Fax:501-801-5561
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARC7708207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5J378Medicare ID - Type Unspecified
ARF78948Medicare UPIN