Provider Demographics
NPI:1316987936
Name:INGRAM, JAMES DAVID (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:DAVID
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:PO BOX 110429
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80042-0429
Mailing Address - Country:US
Mailing Address - Phone:303-493-7000
Mailing Address - Fax:303-493-7202
Practice Address - Street 1:1056 E 19TH AVE
Practice Address - Street 2:B125
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1007
Practice Address - Country:US
Practice Address - Phone:303-761-9190
Practice Address - Fax:303-761-6322
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO307522085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1316987936Medicaid
IA1546838Medicaid
AZ343658Medicaid
COP00123281OtherRR MIC MEDICARE
OK100035760AMedicaid
ID805063700Medicaid
WY109589700Medicaid
NM53820860Medicaid
CO01307529Medicaid
KS100156090CMedicaid
COP00124425OtherRR RIA MEDICARE
MI104686211Medicaid
COP00124424OtherRR DIA MEDICARE
TX169996901Medicaid
CAXPY204028Medicaid
OK100035760AMedicaid
WY109589700Medicaid
MT1316987936Medicaid
MI104686211Medicaid
COC512208Medicare PIN