Provider Demographics
NPI:1013996636
Name:INGRAM, WILLIAM L III (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:L
Last Name:INGRAM
Suffix:III
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 1:915 13TH AVE N
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-5067
Mailing Address - Country:US
Mailing Address - Phone:563-243-2511
Mailing Address - Fax:563-243-0817
Practice Address - Street 1:915 13TH AVE N
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-5067
Practice Address - Country:US
Practice Address - Phone:563-243-2511
Practice Address - Fax:563-243-0817
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35404207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA6424713Medicaid
IA39643OtherWELLMARK BC/BS
110983OtherHEALTH ALLIANCE
IA01B6OtherJOHN DEERE HEALTH
242932OtherMIDLANDS CHOICE
IA39643OtherWELLMARK BC/BS
IAI00626Medicare UPIN
IL$$$$$$$$$Medicaid
242932OtherMIDLANDS CHOICE