Basic Information
| Provider Information | |||||||||
| NPI: | 1689054264 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAGOZA | ||||||||
| FirstName: | YURY | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 731912 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753731912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9038777200 | ||||||||
| FaxNumber: | 9038775080 | ||||||||
| Practice Location | |||||||||
| Address1: | 11937 US HIGHWAY 271 | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757083154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9038777200 | ||||||||
| FaxNumber: | 9038775080 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2015 | ||||||||
| LastUpdateDate: | 05/05/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | BP10053887 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | R1854 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.