Basic Information
| Provider Information | |||||||||
| NPI: | 1457696056 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JAMES A RATLIFF MD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2935 THOUSAND OAKS DR | ||||||||
| Address2: | STE. 294 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782473312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104941100 | ||||||||
| FaxNumber: | 2104941117 | ||||||||
| Practice Location | |||||||||
| Address1: | 17000 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708163246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2253798009 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2012 | ||||||||
| LastUpdateDate: | 12/13/2012 | ||||||||
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| AuthorizedOfficialLastName: | GIBSON | ||||||||
| AuthorizedOfficialFirstName: | TRACY | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 2104941100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MD.203514 | LA | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.