Provider Demographics
NPI:1588861140
Name:RAGNO, DOUGLAS
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:
Last Name:RAGNO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11014 N DALE MABRY HWY STE 504
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-3800
Mailing Address - Country:US
Mailing Address - Phone:813-269-4000
Mailing Address - Fax:813-200-3772
Practice Address - Street 1:922 HIGHWAY 81 E # 365
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252-2978
Practice Address - Country:US
Practice Address - Phone:770-898-4017
Practice Address - Fax:800-385-9610
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA37172171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor