Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 016883 | ME |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 48471 | MN |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 48471 | MN |
N | 207RH0002X | Hospice and Palliative Medicine | 48471 | MN |
N | 207RH0002X | Hospice and Palliative Medicine | 68665 | WI |
NPI | 1104887504 |
---|---|
Provider Name | Dr. Cory J Ingram |
First Address | Rochester, MN 55905-0001 |
Second Address | Rochester, MN 55905-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 14/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I49230 | (02) | ME |