Provider Demographics
NPI:1801897459
Name:INGRAM, JAMES C JR (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:C
Last Name:INGRAM
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:501 DR MICHAEL DEBAKEY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5724
Mailing Address - Country:US
Mailing Address - Phone:337-312-8360
Mailing Address - Fax:337-312-6708
Practice Address - Street 1:1700 KALISTE SALOOM RD
Practice Address - Street 2:BLDG 2 STE 201
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6186
Practice Address - Country:US
Practice Address - Phone:337-534-8346
Practice Address - Fax:337-534-8396
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2015-04-01
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Provider Licenses
StateLicense IDTaxonomies
LAMD 0112662086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1195073Medicaid
LA528657389Medicare PIN
LA397837YH5NMedicare PIN
B64199Medicare UPIN
LA52865Medicare PIN