Healthcare Provider Details

I. General information

NPI: 1881607430
Provider Name (Legal Business Name): GARY ALAN RATKIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 03/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 CHOUTEAU AVE CASA DE SALUD
ST LOUIS MO
63103
US

IV. Provider business mailing address

12217 KINGSHILL DRIVE
ST LOUIS MO
63141
US

V. Phone/Fax

Practice location:
  • Phone: 314-977-1250
  • Fax: 314-977-1255
Mailing address:
  • Phone: 314-434-8865
  • Fax: 314-996-5390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberR3587
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR3587
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: