Provider Demographics
NPI:1124063508
Name:RAGAN, JANE
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:
Last Name:RAGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 LITTON DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5077
Mailing Address - Country:US
Mailing Address - Phone:530-272-9770
Mailing Address - Fax:530-272-9796
Practice Address - Street 1:140 LITTON DR
Practice Address - Street 2:SUITE 110
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5077
Practice Address - Country:US
Practice Address - Phone:530-272-9770
Practice Address - Fax:530-272-9796
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73369207R00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A733690Medicaid
CA00A733692Medicare ID - Type Unspecified
CA00A733690Medicaid