Provider Demographics
NPI:1376544999
Name:INGRAM, GEORGE STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:STEVEN
Last Name:INGRAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 CENTRAL PARKWAY NORTH
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-5024
Mailing Address - Country:US
Mailing Address - Phone:210-541-4500
Mailing Address - Fax:210-541-4508
Practice Address - Street 1:414 NAVARRO ST
Practice Address - Street 2:SUITE #809
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-2516
Practice Address - Country:US
Practice Address - Phone:210-272-1741
Practice Address - Fax:210-272-1747
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9609207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88038XOtherBCBS
TX116071505Medicaid
TXF9609OtherTX LICENSE NUMBER
TX116071504Medicaid
TXF9609OtherTX LICENSE NUMBER
TX116071505Medicaid
TX8B8255Medicare PIN