Provider Demographics
NPI:1972756799
Name:RAGAN, WILLIAM R (PHD, MS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:R
Last Name:RAGAN
Suffix:
Gender:M
Credentials:PHD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 NW 41ST PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-4511
Mailing Address - Country:US
Mailing Address - Phone:352-575-0362
Mailing Address - Fax:
Practice Address - Street 1:4600 NW 41ST PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-4511
Practice Address - Country:US
Practice Address - Phone:352-575-0362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL003443500171M00000X
FLIMH11265390200000X
1744R1102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1744R1102XOther Service ProvidersSpecialistResearch Study
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003443500Medicaid