MEDICARE: DR. MOLUK MIRRASOULI RAGLAND D.O.

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	207Q00000X	Family Medicine Physician	N1423	TX

General Provider Information

NPI Number	:	1407094873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOLUK MIRRASOULI RAGLAND D.O.

Provider Business Mailing Address
First Line	:	2575 NORTHWINDS PKWY
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30009-2232
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7003 S NEW BRAUNFELS AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78223-4588
Country	:	US
Telephone Number	:	678-501-2814
Fax Number	:

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

Provider Enumeration Date	:	01/23/2009
Last Update Date	:	12/05/2024

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