Provider Demographics
NPI:1043535941
Name:RAGSDALE, EIEL E (MD)
Entity Type:Individual
Prefix:
First Name:EIEL
Middle Name:E
Last Name:RAGSDALE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 S SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:VIVIAN
Mailing Address - State:LA
Mailing Address - Zip Code:71082-3200
Mailing Address - Country:US
Mailing Address - Phone:318-375-3239
Mailing Address - Fax:
Practice Address - Street 1:1003 S SPRUCE ST
Practice Address - Street 2:
Practice Address - City:VIVIAN
Practice Address - State:LA
Practice Address - Zip Code:71082-3200
Practice Address - Country:US
Practice Address - Phone:318-375-3239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-02
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA205682207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1038130Medicaid
5D072Medicare PIN
LA1038130Medicaid