Provider Demographics
NPI:1417096389
Name:INGRAM, WALTER N (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:N
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 1:404 MAINE ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-1361
Mailing Address - Country:US
Mailing Address - Phone:785-505-5635
Mailing Address - Fax:785-505-5306
Practice Address - Street 1:404 MAINE ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044
Practice Address - Country:US
Practice Address - Phone:785-505-5635
Practice Address - Fax:785-505-5306
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK41524208M00000X
VA0101238425207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist