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1083620686
KENNETH DALE INGRAM
PORTLAND, OR
NPI
1083620686
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: OR PA00660)
Enumeration Date
2006-08-01
Last Update Date
2007-07-10
Business Address
KENNETH DALE INGRAM PA
3181 SW SAM JACKSON PARK RD L-461
PORTLAND, OR 97239-3011
Phone number: 503-494-8577
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Mailing Address
KENNETH DALE INGRAM PA
3181 SW SAM JACKSON PARK RD 3181 SW SAM JACKSON PARK RD
PORTLAND, OR 97239-3011
Phone number:
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