Provider Demographics
NPI:1386779940
Name:RAGSDALE, RICHARD L (DO)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:RAGSDALE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 CENTRAL EXPY N
Mailing Address - Street 2:STE 210
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-6103
Mailing Address - Country:US
Mailing Address - Phone:972-747-4646
Mailing Address - Fax:972-747-4633
Practice Address - Street 1:1105 CENTRAL EXPY N
Practice Address - Street 2:STE 210
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6103
Practice Address - Country:US
Practice Address - Phone:972-747-4646
Practice Address - Fax:972-747-4633
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD0G3716207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
8D2348Medicare ID - Type Unspecified
TXA10575Medicare UPIN