Provider Demographics
NPI:1912960238
Name:RAGLAND, DARRELL G (MD)
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:G
Last Name:RAGLAND
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 1:415 E MATTHEWS AVE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-3142
Mailing Address - Country:US
Mailing Address - Phone:870-972-8181
Mailing Address - Fax:870-935-8749
Practice Address - Street 1:415 E MATTHEWS AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3142
Practice Address - Country:US
Practice Address - Phone:870-972-8181
Practice Address - Fax:870-935-8749
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC6872207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR12856000040OtherQUALCHOICE
AR12856000040OtherQUALCHOICE
ARD04320Medicare UPIN