Healthcare Provider Details

I. General information

NPI: 1003079583
Provider Name (Legal Business Name): EMMETT DAVID RATIGAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2008
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 LUTHERAN PKWY BLDG 10 SUITE 200
WHEAT RIDGE CO
80033-6017
US

IV. Provider business mailing address

130 RAMPART WAY SUITE 300B
DENVER CO
80230-6440
US

V. Phone/Fax

Practice location:
  • Phone: 720-536-2100
  • Fax: 720-536-2090
Mailing address:
  • Phone: 303-327-4700
  • Fax: 303-327-4711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number54717
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier411559YVBJ
Identifier TypeOTHER
Identifier StateCO
Identifier IssuerPTAN
# 2
Identifier55407251
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: