Healthcare Provider Details

I. General information

NPI: 1730175043
Provider Name (Legal Business Name): KEENER B RAGSDALE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BLAKE RAGSDALE

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 07/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 MOUNT PELIA RD
MARTIN TN
38237-3812
US

IV. Provider business mailing address

3249 W SARAZENS CIR
MEMPHIS TN
38125-0807
US

V. Phone/Fax

Practice location:
  • Phone: 731-587-5900
  • Fax: 731-587-5908
Mailing address:
  • Phone: 901-756-5565
  • Fax: 901-756-5564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD00000013458
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: