Provider Demographics
NPI:1700859147
Name:INGRAM, DEBORAH E (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:E
Last Name:INGRAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4100 S HOSPITAL DR STE 302
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2838
Mailing Address - Country:US
Mailing Address - Phone:954-321-1591
Mailing Address - Fax:954-321-1592
Practice Address - Street 1:4100 S HOSPITAL DR STE 302
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2838
Practice Address - Country:US
Practice Address - Phone:954-321-1591
Practice Address - Fax:954-321-1592
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2024-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79116208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261906700Medicaid
H46156Medicare UPIN
FL261906700Medicaid