Provider Demographics
NPI:1841449345
Name:MATTHEW M RAGSDELL DO PC
Entity type:Organization
Organization Name:MATTHEW M RAGSDELL DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAGSDELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-564-1234
Mailing Address - Street 1:1681 W. HORIZON RIDGE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-7692
Mailing Address - Country:US
Mailing Address - Phone:702-564-1234
Mailing Address - Fax:702-564-3361
Practice Address - Street 1:1681 W HORIZON RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-3494
Practice Address - Country:US
Practice Address - Phone:702-564-1234
Practice Address - Fax:702-564-3361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO1387207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty