Provider Demographics
NPI:1205829959
Name:RAGSDALE, TIMOTHY F (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:F
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 1:1615 HOSPITAL PKWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-5934
Mailing Address - Country:US
Mailing Address - Phone:817-540-3121
Mailing Address - Fax:817-355-4511
Practice Address - Street 1:1615 HOSPITAL PKWY
Practice Address - Street 2:SUITE 210
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-5934
Practice Address - Country:US
Practice Address - Phone:817-540-3121
Practice Address - Fax:817-355-4511
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2744207Y00000X
TN34520207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4086723OtherBLUE CROSS BLUE SHIELD
TN62089728905OtherUHC RIVER VALLEY
KY000000049993OtherBLUEGRASS
TN7689535OtherAETNA
TN3891058Medicaid
KY000000363275OtherANTHEM BLUE CROSS
TN100045915OtherPHP TENNCARE
KY64098965Medicaid
TN100045915OtherPHP TENNCARE
TN3891058Medicaid
KY0246305Medicare ID - Type Unspecified