Provider Demographics
NPI:1629291398
Name:RAGLE, CAROL (DOM)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:RAGLE
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2258 N PINOS ALTOS RD
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-7865
Mailing Address - Country:US
Mailing Address - Phone:505-538-0559
Mailing Address - Fax:
Practice Address - Street 1:2258 N PINOS ALTOS RD
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-7865
Practice Address - Country:US
Practice Address - Phone:505-538-0559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM342171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM342OtherSTATE LICENSE