Provider Demographics
NPI:1306102603
Name:RAGON, BETTY JO
Entity type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:JO
Last Name:RAGON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 314
Mailing Address - Street 2:1558 C R 3040
Mailing Address - City:DODD CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75438-0314
Mailing Address - Country:US
Mailing Address - Phone:903-640-2241
Mailing Address - Fax:903-640-2242
Practice Address - Street 1:1558 C R 3040
Practice Address - Street 2:
Practice Address - City:DODD CITY
Practice Address - State:TX
Practice Address - Zip Code:75438
Practice Address - Country:US
Practice Address - Phone:903-640-2241
Practice Address - Fax:903-640-2242
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant