Provider Demographics
NPI:1548205198
Name:RAGLAND, DOUGLAS W (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:W
Last Name:RAGLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9131 CROCUS AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-1434
Mailing Address - Country:US
Mailing Address - Phone:949-339-7766
Mailing Address - Fax:
Practice Address - Street 1:101 MISSION ST STE 800
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94105-1744
Practice Address - Country:US
Practice Address - Phone:949-339-7766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC56101207Q00000X
AZ15721207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ28951301Medicaid
D44375Medicare UPIN