Healthcare Provider Details

I. General information

NPI: 1366448078
Provider Name (Legal Business Name): JAMES R RAGON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 02/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 PARKVIEW CV
PIPERTON TN
38017-5389
US

IV. Provider business mailing address

45 PARKVIEW CV
PIPERTON TN
38017-5389
US

V. Phone/Fax

Practice location:
  • Phone: 901-755-8516
  • Fax:
Mailing address:
  • Phone: 901-755-8516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number51354
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: