Provider Demographics
NPI:1801890207
Name:RAGSDALE, DORRIS A (MD)
Entity type:Individual
Prefix:
First Name:DORRIS
Middle Name:A
Last Name:RAGSDALE
Suffix:
Gender:F
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 457
Mailing Address - Street 2:5 E ALVON ROAD, SUITE 7
Mailing Address - City:WHITE SULPHUR SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:24986-2373
Mailing Address - Country:US
Mailing Address - Phone:304-536-5030
Mailing Address - Fax:304-536-5051
Practice Address - Street 1:3738 DAVIS STUART RD
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-9463
Practice Address - Country:US
Practice Address - Phone:304-645-3207
Practice Address - Fax:304-645-3128
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV13172207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0083785000Medicaid
4340524OtherAETNA
WV541839718017OtherBS MOUNTAIN STATE
72692OtherCARELINK
541839718OtherC&O
3076165OtherCIGNA
5181468OtherCCN
WV54183971800OtherWV WORKERS COMPENSATION
200026OtherLUNG
VA262072OtherANTHEM
72692OtherSOUTHERN HEALTH
1200890007Medicare ID - Type UnspecifiedADMINSTAR FEDERAL
F03890Medicare UPIN
159679Medicare ID - Type UnspecifiedUMWA
3076165OtherCIGNA
5181468OtherCCN