Provider Demographics
NPI:1386021939
Name:INGRAM, JOHN M JR (CCP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:INGRAM
Suffix:JR
Gender:M
Credentials:CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9632 NW 7TH CIR
Mailing Address - Street 2:APT 1718
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-7533
Mailing Address - Country:US
Mailing Address - Phone:954-931-0420
Mailing Address - Fax:
Practice Address - Street 1:9632 NW 7TH CIR
Practice Address - Street 2:APT 1718
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-7533
Practice Address - Country:US
Practice Address - Phone:954-931-0420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-04
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist