Provider Demographics
NPI:1669421954
Name:INGRAM, WILLIAM A (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
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 1:18015 OAK ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-6097
Mailing Address - Country:US
Mailing Address - Phone:402-991-1975
Mailing Address - Fax:402-991-1974
Practice Address - Street 1:18015 OAK ST
Practice Address - Street 2:SUITE B
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-6097
Practice Address - Country:US
Practice Address - Phone:402-991-1975
Practice Address - Fax:402-991-1974
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21807207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47078557504Medicaid
NE10025914000Medicaid
45494OtherBCBS OF NEBRASKA
NE47078557504Medicaid
NE10025914000Medicaid
NENA1786001Medicare PIN