Provider Demographics
NPI:1831122738
Name:RAGAN, JOHN J (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:RAGAN
Suffix:
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:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:701-364-8000
Mailing Address - Fax:701-364-8078
Practice Address - Street 1:3000 32ND AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6132
Practice Address - Country:US
Practice Address - Phone:701-364-8000
Practice Address - Fax:701-364-8078
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND9026207RC0000X
MN45285207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDND200233OtherLHS #
ND023L1RAOtherMNBS #
ND040502700Medicaid
ND1630861OtherAMERICA'S PPO/ARAZ #
NDDA9011031161OtherPREFERRED ONE #
ND11901Medicaid
ND2500737OtherMEDICA #
ND142759OtherUCARE #
NDHP38402OtherHEALTHPARTNERS #
ND21998OtherNDBS #
ND11901Medicaid
ND040502700Medicaid
ND142759OtherUCARE #
NDG54360Medicare UPIN
MN060001592Medicare ID - Type UnspecifiedMN MEDICARE #
ND060068046Medicare ID - Type UnspecifiedRR MEDICARE #
NDDA9011031161OtherPREFERRED ONE #
ND2500737OtherMEDICA #
ND1630861OtherAMERICA'S PPO/ARAZ #
ND21998Medicare ID - Type UnspecifiedND MEDICARE #