Healthcare Provider Details

I. General information

NPI: 1629196811
Provider Name (Legal Business Name): MATTHEW M RAGSDELL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 PASADENA AVE S STE 290
SOUTH PASADENA FL
33707-4517
US

IV. Provider business mailing address

1615 PASADENA AVE S STE 290
SOUTH PASADENA FL
33707-4517
US

V. Phone/Fax

Practice location:
  • Phone: 727-826-0329
  • Fax: 727-202-7193
Mailing address:
  • Phone: 727-826-0329
  • Fax: 727-202-7193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number2004015332
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number5101015376
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberOS13422
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: