Provider Demographics
NPI:1659326023
Name:RAGOTERO, SOLOMON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:SOLOMON
Middle Name:
Last Name:RAGOTERO
Suffix:JR
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 1:530 PENINSULA DR
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-8705
Mailing Address - Country:US
Mailing Address - Phone:870-312-0838
Mailing Address - Fax:
Practice Address - Street 1:530 PENINSULA DR
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-8705
Practice Address - Country:US
Practice Address - Phone:870-312-0838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-4730207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2136810Medicaid
AR5N535Medicare ID - Type Unspecified
AR1659326023Medicare PIN