Provider Demographics
NPI:1689608747
Name:INGRAM, DANNY P (MD)
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:P
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:PO DRAWER 681330
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36068-1330
Mailing Address - Country:US
Mailing Address - Phone:334-365-2205
Mailing Address - Fax:334-361-7975
Practice Address - Street 1:PO DRAWER 681330
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36068-1330
Practice Address - Country:US
Practice Address - Phone:334-365-2205
Practice Address - Fax:334-361-7975
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10401207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1326184029OtherORGANIZATION NPI
AL000030008Medicaid
000030008Medicare ID - Type Unspecified
AL1326184029OtherORGANIZATION NPI