Provider Demographics
NPI:1578661161
Name:RAGSDALE, EDWARD F (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:F
Last Name:RAGSDALE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:55 WESTPORT PLAZA DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146
Mailing Address - Country:US
Mailing Address - Phone:314-548-4772
Mailing Address - Fax:314-548-4748
Practice Address - Street 1:ONE MEDICAL DRIVE
Practice Address - Street 2:ALTON MEMORIAL HOSPITAL
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002
Practice Address - Country:US
Practice Address - Phone:618-463-7415
Practice Address - Fax:314-821-2180
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2024-03-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL0360432472085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
431725842MIDOtherMERCY
MO208652602Medicaid
300066976OtherRR MEDICARE
1609009OtherPH PLAN
300066971OtherRR MEDICARE
C47060OtherGATEWAY
0006021895OtherIL BLUE
102149OtherHLINK
IL0360432471Medicaid
134024OtherBLUE CHOICE
300380OtherHLT PART
300066981OtherRR MEDICARE
2781OtherGHP
46064OtherHCARE USA
ILL40192Medicare ID - Type Unspecified
0006021895OtherIL BLUE
300380OtherHLT PART