Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VG0400X | Gynecologist | E7995 | TX |
N | 208200000X | Surgeon | E7795 | TX |
N | 208600000X | Surgeon | E7795 | TX |
NPI | 1134120702 |
---|---|
Provider Name | Dr. Wayne W Ingram |
First Address | Austin, TX 78705-1121 |
Second Address | Austin, TX 78705-1121 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C17299 | (02) |