Provider Demographics
NPI:1609856269
Name:INGRAHAM, ROBERT QUINN II (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:QUINN
Last Name:INGRAHAM
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5201 NORTHSHORE DR, STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72118
Mailing Address - Country:US
Mailing Address - Phone:501-225-0880
Mailing Address - Fax:501-225-5694
Practice Address - Street 1:5201 NORTHSHORE DR, STE 100
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72118
Practice Address - Country:US
Practice Address - Phone:501-225-0880
Practice Address - Fax:501-225-5694
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS26951207T00000X
ARE-12839207T00000X
TN36988207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3878893Medicaid
TN3878893Medicare ID - Type Unspecified
TN3878893Medicaid
140008340Medicare PIN