Healthcare Provider Details

I. General information

NPI: 1194106625
Provider Name (Legal Business Name): COLTON LEE RAGSDALE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2015
Last Update Date: 07/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2084 N 1700 W SUITE A
LAYTON UT
84041
US

IV. Provider business mailing address

2084 N 1700 W SUITE A
LAYTON UT
84041
US

V. Phone/Fax

Practice location:
  • Phone: 801-773-8644
  • Fax: 801-927-1591
Mailing address:
  • Phone: 801-773-8644
  • Fax: 801-927-1591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberLL38446
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number106470301205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: