MEDICARE: BRUCE D RAGSDALE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZD0900X	Dermatopathology (Pathology) Physician	A23785	CA
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	A23785	CA
3	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician	A23785	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225072374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE D RAGSDALE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 8139
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93403-8139
Country	:	US
Telephone Number	:	805-541-6033
Fax Number	:	805-549-7463

Provider Business Practice Location Address
First Line	:	3701 S HIGUERA ST
Second Line	:	STE 200
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-7462
Country	:	US
Telephone Number	:	805-541-6033
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	03/07/2023

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Directions to “ BRUCE D RAGSDALE M.D.” Practice Location

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