Healthcare Provider Details

I. General information

NPI: 1205982089
Provider Name (Legal Business Name): DENNY RAGSDALE MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 12/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 ORLANDO BLVD
INDIALANTIC FL
32903-3421
US

IV. Provider business mailing address

222 ORLANDO BLVD
INDIALANTIC FL
32903-3421
US

V. Phone/Fax

Practice location:
  • Phone: 321-432-9565
  • Fax: 321-722-1764
Mailing address:
  • Phone: 321-432-9564
  • Fax: 321-722-1764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME13755
License Number StateFL

VIII. Authorized Official

Name: VERNICE D RAGSDALE
Title or Position: PRESIDENT
Credential: MD
Phone: 321-432-9564