Provider Demographics
NPI:1801877428
Name:RAGSDALE, SARA (DO)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:RAGSDALE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 W PINE STREET
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99156-9146
Mailing Address - Country:US
Mailing Address - Phone:509-447-4885
Mailing Address - Fax:509-447-9350
Practice Address - Street 1:714 W PINE STREET
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:WA
Practice Address - Zip Code:99156-9146
Practice Address - Country:US
Practice Address - Phone:509-447-4885
Practice Address - Fax:509-447-9350
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0528424174400000X
WAOP00002311207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807920700Medicaid
KS100389240BMedicaid
WA8502734Medicaid
KS100389240BMedicaid
KSH34572Medicare UPIN