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General NPI Number Information
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NPI Number | 1558700104
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Entity Type | Individual
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Provider Name | TADD OLIN KNOX RAGSDALE IDMT
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Gender | Male
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Dates
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Enumeration Date | 06/17/2013
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Last Update Date | 06/17/2013
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Provider Practice Location Address
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Address Line | 3062 TROUTMAN DR
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City | BEALE AFB
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State | CA
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Zip | 95903-2329
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Country | US
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Telephone | 916-757-4603
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Fax |
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Provider Business Mailing Address
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Address Line | 3062 TROUTMAN DR
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City | BEALE AFB
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State | CA
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Zip | 95903-2329
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Country | US
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Telephone | 916-757-4603
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Fax |
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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 | 1710I1003X
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Taxonomy Name | Independent Duty Medical Technicians
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License Number |
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License Number State |
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