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General NPI Number Information
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NPI Number | 1497174189
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Entity Type | Individual
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Provider Name | BLAKE STEPHEN RAGGIO MD
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Gender | Male
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Dates
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Enumeration Date | 04/10/2014
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Last Update Date | 07/17/2020
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Provider Practice Location Address
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Address Line | 1111 OLIVE ST
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City | MONTGOMERY
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State | AL
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Zip | 36106-1129
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Country | US
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Telephone | 334-834-7221
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Fax | 334-241-9848
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Provider Business Mailing Address
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Address Line | 1722 PINE ST STE 203
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City | MONTGOMERY
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State | AL
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Zip | 36106-1158
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Country | US
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Telephone | 334-293-8736
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Fax | 334-293-8738
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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 | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | MD.40981
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License Number State | AL
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