Individual
BRIAN R RAGUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1160 KEPLER DR, GREEN BAY, WI 54311
(920) 288-5555
(920) 288-5550
Mailing address
116 KEPLER DR, PO BOX 8970, GREEN BAY, WI 54308-8970
(920) 288-5555
(920) 288-5550
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1663
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41980900
—
WI
Enumeration date
08/12/2006
Last updated
09/30/2008
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