Provider Demographics
NPI:1609829225
Name:INGRAM, RONALD W (PA)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:W
Last Name:INGRAM
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2706 W CUTHBERT
Mailing Address - Street 2:STE A
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701
Mailing Address - Country:US
Mailing Address - Phone:432-694-0999
Mailing Address - Fax:432-694-7414
Practice Address - Street 1:2706 W CUTHBERT
Practice Address - Street 2:STE A
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701
Practice Address - Country:US
Practice Address - Phone:432-694-0999
Practice Address - Fax:432-694-7414
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2481207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX003712Medicare ID - Type Unspecified
B65304Medicare UPIN