KENNETH DALE INGRAM

PORTLAND, OR
NPI1083620686
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363A00000X Physician Assistant
(Licence: OR  PA00660)
Enumeration Date2006-08-01
Last Update Date2007-07-10
Business Address
KENNETH DALE INGRAM PA
3181 SW SAM JACKSON PARK RD L-461
PORTLAND, OR 97239-3011
Phone number: 503-494-8577
Mailing Address
KENNETH DALE INGRAM PA
3181 SW SAM JACKSON PARK RD 3181 SW SAM JACKSON PARK RD
PORTLAND, OR 97239-3011
Phone number: