Provider Demographics
NPI:1942460803
Name:RAGLE, NATHAN JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:JOHN
Last Name:RAGLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:555 FOOTHILL BLVD
Mailing Address - Street 2:SUITE # 203
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-0001
Mailing Address - Country:US
Mailing Address - Phone:801-581-7790
Mailing Address - Fax:801-581-8937
Practice Address - Street 1:555 FOOTHILL BLVD
Practice Address - Street 2:SUITE # 203
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-581-7790
Practice Address - Fax:801-581-8937
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-13
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT6805261-1205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine