Provider Demographics
NPI:1407094873
Name:RAGLAND, MOLUK MIRRASOULI (DO)
Entity Type:Individual
Prefix:DR
First Name:MOLUK
Middle Name:MIRRASOULI
Last Name:RAGLAND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MISS
Other - First Name:MOLUK
Other - Middle Name:SADAT
Other - Last Name:MIRRASOULI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2575 NORTHWINDS PKWY
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-2232
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7003 S NEW BRAUNFELS AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-4588
Practice Address - Country:US
Practice Address - Phone:678-501-2814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-23
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1423207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine