Provider Demographics
NPI:1932403987
Name:INGRAM, HOLLY R (DO)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:R
Last Name:INGRAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5930 BAY SPRINGS LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-8136
Mailing Address - Country:US
Mailing Address - Phone:817-851-7599
Mailing Address - Fax:
Practice Address - Street 1:4102 PINION DR
Practice Address - Street 2:
Practice Address - City:USAF ACADEMY
Practice Address - State:CO
Practice Address - Zip Code:80840
Practice Address - Country:US
Practice Address - Phone:719-524-2273
Practice Address - Fax:719-333-1249
Is Sole Proprietor?:No
Enumeration Date:2011-01-05
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-1600-11207Q00000X
CODR.0057385207Q00000X
TXN7436207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX293167702Medicaid
TX8ED361OtherBCBS
TX293167702Medicaid