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General NPI Number Information
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NPI Number | 1194106625
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Entity Type | Individual
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Provider Name | COLTON LEE RAGSDALE M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/10/2015
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Last Update Date | 07/20/2018
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Provider Practice Location Address
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Address Line | 2084 N 1700 W SUITE A
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City | LAYTON
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State | UT
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Zip | 84041
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Country | US
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Telephone | 801-773-8644
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Fax | 801-927-1591
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Provider Business Mailing Address
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Address Line | 2084 N 1700 W SUITE A
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City | LAYTON
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State | UT
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Zip | 84041
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Country | US
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Telephone | 801-773-8644
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Fax | 801-927-1591
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | LL38446
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 106470301205
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License Number State | UT
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