Basic Information
Provider Information
NPI: 1033559208
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RATLIFF
FirstName: MARK
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: DVM
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 11 RHUBENS BR
Address2:  
City: LOUISA
State: KY
PostalCode: 412306714
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 11 RHUBENS BR
Address2:  
City: LOUISA
State: KY
PostalCode: 412306714
CountryCode: US
TelephoneNumber: 6066731144
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/02/2013
LastUpdateDate: 07/02/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
174M00000X2883KYY Other Service ProvidersVeterinarian 

No ID Information.


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