Provider Demographics
NPI:1063730679
Name:RAGER, TERRENCE MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:TERRENCE
Middle Name:MICHAEL
Last Name:RAGER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:777 HOSPITAL WAY STE 201
Mailing Address - Street 2:SOUTH MEDICAL OFFICE BUILDING, STE 201
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-5175
Mailing Address - Country:US
Mailing Address - Phone:208-239-2620
Mailing Address - Fax:208-239-3778
Practice Address - Street 1:PORTNEUF MEDICAL CENTER
Practice Address - Street 2:777 HOSPITAL WAY, SOUTH MOB, SUITE 201
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201
Practice Address - Country:US
Practice Address - Phone:208-239-2620
Practice Address - Fax:208-239-3778
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2019-06-11
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Provider Licenses
StateLicense IDTaxonomies
IDM-13764208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID808437000Medicaid