Provider Demographics
NPI:1386633402
Name:RAGLAND, JOEL BRYAN (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:BRYAN
Last Name:RAGLAND
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 1:9314 PARK WEST BLVD
Mailing Address - Street 2:200 MEDICAL ARTS BLDG
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4353
Mailing Address - Country:US
Mailing Address - Phone:865-694-0577
Mailing Address - Fax:865-694-4720
Practice Address - Street 1:9314 PARK WEST BLVD
Practice Address - Street 2:200 MEDICAL ARTS BLDG
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4353
Practice Address - Country:US
Practice Address - Phone:865-694-0577
Practice Address - Fax:865-694-4720
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD25341207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3085988Medicaid
F89277Medicare UPIN
TN3085988Medicare ID - Type Unspecified