Provider Demographics
NPI:1841319068
Name:INGRAM, CHRISTINA GUYTON (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:GUYTON
Last Name:INGRAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:LYNN
Other - Last Name:GUYTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4055 LINDELL BLVD.
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-3201
Mailing Address - Country:US
Mailing Address - Phone:314-535-7701
Mailing Address - Fax:314-535-0207
Practice Address - Street 1:4055 LINDELL BLVD.
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103-3201
Practice Address - Country:US
Practice Address - Phone:314-535-7701
Practice Address - Fax:314-535-0207
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO106585208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics