Provider Demographics
NPI:1477714137
Name:RAGO, JOSE IVAN (MD)
Entity Type:Individual
Prefix:
First Name:JOSE IVAN
Middle Name:
Last Name:RAGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOVAN
Other - Middle Name:
Other - Last Name:RAGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8125 N HAYDEN RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-2463
Mailing Address - Country:US
Mailing Address - Phone:623-584-1181
Mailing Address - Fax:
Practice Address - Street 1:287 E. HUNT HIGHWAY
Practice Address - Street 2:SUITE 105
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85143-5096
Practice Address - Country:US
Practice Address - Phone:480-677-8282
Practice Address - Fax:480-677-8283
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR70138390200000X
AZ42140207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1477714137OtherMEDICARE-NPI
AZ463254Medicaid
AZ463254Medicaid