Basic Information
| Provider Information | |||||||||
| NPI: | 1700872140 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RATCLIFF | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | CRAIG | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 419 S WASHINGTON ST | ||||||||
| Address2: | SUITE102 | ||||||||
| City: | CASPER | ||||||||
| State: | WY | ||||||||
| PostalCode: | 826012951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3075774220 | ||||||||
| FaxNumber: | 3072350931 | ||||||||
| Practice Location | |||||||||
| Address1: | 214 SOUTH 4TH STREET | ||||||||
| Address2: | |||||||||
| City: | KREMMLING | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804590399 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708875800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2005 | ||||||||
| LastUpdateDate: | 02/06/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 4228A | WY | N | Allopathic & Osteopathic Physicians | Surgery | 208C00000X | 4228A | WY | N | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | 208600000X | 56354 | CO | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 312911 | 01 | WY | BLUE CROSS BLUE SHIELD | OTHER | 107011800 | 05 | WY | MEDICAID |