Basic Information
| Provider Information | |||||||||
| NPI: | 1316987936 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | INGRAM | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 110429 | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800420429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034937000 | ||||||||
| FaxNumber: | 3034937202 | ||||||||
| Practice Location | |||||||||
| Address1: | 1056 E 19TH AVE | ||||||||
| Address2: | B125 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802181007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | 3037616322 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 10/10/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 30752 | CO | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1316987936 | 05 | MT | MEDICAID | 1546838 | 05 | IA | MEDICAID | 343658 | 05 | AZ | MEDICAID | P00123281 | 01 | CO | RR MIC MEDICARE | OTHER | 100035760A | 05 | OK | MEDICAID | 805063700 | 05 | ID | MEDICAID | 109589700 | 05 | WY | MEDICAID | 53820860 | 05 | NM | MEDICAID | 01307529 | 05 | CO | MEDICAID | 100156090C | 05 | KS | MEDICAID | P00124425 | 01 | CO | RR RIA MEDICARE | OTHER | 104686211 | 05 | MI | MEDICAID | P00124424 | 01 | CO | RR DIA MEDICARE | OTHER | 169996901 | 05 | TX | MEDICAID | XPY204028 | 05 | CA | MEDICAID |